Escitalopram and paroxetine in the treatment of generalised anxiety disorder: Randomised, placebo-controlled, double-blind study
Open accessAbstract
Background: It is uncertain whether higher doses of selective serotonin reuptake inhibitors have greater efficacy in generalised anxiety disorder. Aims: To assess the efficacy of different doses of escitalopram in generalised anxiety disorder. Method: Randomised, double-blind, placebo-controlled, fixed-dose, parallel-group, 12-week study, with 681 patients: placebo (n=139); escitalopram, 5 mg/day, (n=134); 10 mg/day (n=136); 20 mg/day (n=133); paroxetine, 20 mg/day (n=139). Results: Mean change in the primary efficacy measure was greater with escitalopram 10 and 20 mg than with placebo; 10 mg was more efficacious than paroxetine. Paroxetine was superior to placebo on some secondary measures, at sometime points. Compared with placebo, more patients withdrew because of adverse events with escitalopram 20 mg and paroxetine. Conclusions: Escitalopram was efficacious in generalised anxiety disorder, 20 was not significantly superior to 10 mg/day Escitalopram 10 mg was more efficacious than paroxetine.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Randomised studies with tapering periods up to 14 days showed no or minimal reduction in withdrawal symptom severity compared with abrupt discontinuation.
“randomised studies with a tapering period up to 14 days showed either no or minimal reduction in withdrawal symptom severity compared with abrupt discontinuation (Baldwin 2006;Bogetto 2002;Montgomery 2004a).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Baldwin 2006
The Tolerability assessments section describes a randomized comparison of stopping treatment immediately versus continuing the same dose for one more week before stopping—not tapering versus abrupt discontinuation. The DESS results section says the dose-reduction group had no randomized withdrawal comparison and omits its results from the figure. This paper therefore does not show that tapering reduced withdrawal symptoms minimally or not at all compared with abrupt discontinuation. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAnimal studies concerned with the long-term use of antidepressants have limited implications for understanding SSRI discontinuation because clear discontinuation-like behaviors in animal models are not available.
“Animal studies concerned with the longterm use of AD have limited implications, since clear discontinuation-like behaviors in animal models are not available [28] .”
From Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review (2015) · cites this paper as [28]
The Tolerability assessments and Discussion passages describe discontinuation symptoms in human patients after stopping SSRIs. Searches for animal studies and discontinuation-like behaviors in animal models found no passage addressing whether such behaviors are available or what that means for interpreting long-term antidepressant studies. Page numbers were not provided in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962 · see citing works
The assessment of anxiety states by rating
HAMILTON, M. (1959) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1959.tb00467.x · Cited by 11,455 · see citing works
(1976) · Medical Entomology and Zoology · Cited by 8,899 · see citing works
The mini international neuropsychiatric interview
Lecrubier, Y., Sheehan, D. V., Hergueta, T., & Weiller, E. (1998) · European Psychiatry · doi:10.1016/s0924-9338(99)80239-9 · Cited by 5,882 · see citing works
Department of Health, Education, and Welfare
Cooper, T. (1976) · Military Medicine · doi:10.1093/milmed/141.8.521 · Cited by 3,994 · see citing works
Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial
Rosenbaum, J. F., Fava, M., Hoog, S. L., Ascroft, R. C., & Krebs, W. B. (1998) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00126-7 · Cited by 574 · see citing works
ICH Harmonised Tripartite Guideline: Guideline for Good Clinical Practice.
Bhuiyan, P. S., & Rege, N. N. (2002) · PubMed · Cited by 531 · see citing works
Cooper, J. E. (2001) · The British Journal of Psychiatry · doi:10.1192/bjp.179.1.85-a · Cited by 425 · see citing works
Fixed-Dose Trial of the Single Isomer SSRI Escitalopram in Depressed Outpatients
Burke, W. J., Gergel, I. P., & Bose, A. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n0410 · Cited by 352 · see citing works
The epidemiology of generalized anxiety disorder
Kessler, R. C., Keller, M. B., & Wittchen, H.-U. (2001) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(05)70204-5 · Cited by 337 · see citing works
Lepola, U. M., Loft, H., & Reines, E. H. (2003) · International Clinical Psychopharmacology · doi:10.1097/01.yic.0000074988.54339.7c · Cited by 254 · see citing works
Paroxetine in the Treatment of Generalized Anxiety Disorder
Pollack, M. H., Zaninelli, R., Goddard, A. W., McCafferty, J. P., Bellew, K. M., Burnham, D. B., & Iyengar, M. K. (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n0508 · Cited by 246 · see citing works
Paroxetine Treatment of Generalized Anxiety Disorder: A Double-Blind, Placebo-Controlled Study
Rickels, K., Zaninelli, R., McCafferty, J. P., Bellew, K. M., Iyengar, M. K., & Sheehan, D. V. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.4.749 · Cited by 197 · see citing works
Davidson, J. R. T., Bose, A., Korotzer, A., & Zheng, H. (2004) · Depression and Anxiety · doi:10.1002/da.10146 · Cited by 183 · see citing works
Lader, M., Stender, K., Bürger, V., & Nil, R. (2004) · Depression and Anxiety · doi:10.1002/da.20014 · Cited by 163 · see citing works
Katz, I. R., Reynolds, C. F., Alexopoulos, G. S., & Hackett, D. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50003.x · Cited by 158 · see citing works
Efficacy of Sertraline in a 12-Week Trial for Generalized Anxiety Disorder
Allgulander, C., Dahl, A. A., Austin, C., Morris, P., Søgaard, J., Fayyad, R. S., Kutcher, S., & Clary, C. M. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.9.1642 · Cited by 139 · see citing works
Evidence-based pharmacotherapy of Generalized Anxiety Disorder
Baldwin, D. S., & Polkinghorn, C. (2005) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145704004870 · Cited by 126 · see citing works
Self-citationGoodman, W. K., Bose, A., & Wang, Q. (2005) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.11.011 · Cited by 117 · see citing works
Bielski, R. J., Bose, A., & Chang, C.-C. (2005) · Annals of Clinical Psychiatry · doi:10.1080/10401230590932326 · Cited by 109 · see citing works
Sertraline Treatment for Generalized Anxiety Disorder
Brawman‐Mintzer, O., Knapp, R. G., Rynn, M. A., Carter, R. E., & Rickels, K. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0603 · Cited by 72 · see citing works
Everitt, B. J., & Wessely, S. C. (2007) · Wiley eBooks · doi:10.1002/9780470723852 · Cited by 51 · see citing works
Everitt, B. J., & Wessely, S. C. (2003) · doi:10.1093/oso/9780198526421.001.0001 · Cited by 32 · see citing works
A modelling strategy for the analysis of clinical trials with partly missing longitudinal data
White, I. R., Moodie, E. E. M., Thompson, S. G., et al. (2003) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.150 · Cited by 24 · see citing works
ECNP Consensus Meeting March 2000
Montgomery, D. (2002) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(01)00147-x · Cited by 12 · see citing works
Paroxetine in the treatment of generalised anxiety disorder
Snyderman, S. H., Rynn, M. A., Bellew, K. M., & Rickels, K. (2004) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.5.8.1799 · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [3]3. Allgulander, C., Florea, I. & Huusom, A. K. T. (2005) Prevention of relapse in generalised anxiety disorder by Prevention of relapse in generalised anxiety disorder by escitalopram treatment. escitalopram treatment. International Journal of International Journal of Neuropsychopharmacology Neuropsychopharmacology, 2005. doi: 10.1017/ , 2005. doi: 10.1017/ S1461145705005973 S1461145705005973 American Psychiatric Association (2000) American Psychiatric Association (2000) Diagnostic Diagnostic and Statistical Manual of Mental Disorders and Statistical Manual of Mental Disorders (4th edn, text (4th edn, text revision) (DSM ^IV^TR).Washigton, DC: APA. revision) (DSM ^IV^TR).Washigton, DC: APA.
- [5]5. Baldwin, D. S. & Polkinghorn, C. (2005) Evidence- Evidence- based pharmacological treatment of generalised anxiety based pharmacological treatment of generalised anxiety disorder. disorder. International Journal of International Journal of Neuropsychopharmacology Neuropsychopharmacology, , 8 8, 293^302. , 293^302.
- [23]23. ANNA KARINA TRAP HUUSOM, MSc, H. Lundbeck A/S, Copenhagen, Denmark; ELI MÓHLUM, MSc, ANNA KARINATRAP HUUSOM, MSc, H. Lundbeck A/S, Copenhagen, Denmark; ELI MÓHLUM, MSc, H. Lundbeck A/S, Lysaker, Norway H. Lundbeck A/S, Lysaker, Norway Correspondence: David S.Baldwin,University Department of Mental Health, Royal South Hants Correspondence: David S.Baldwin,University Department of Mental Health, Royal South Hants Hospital,Graham Road, Southampton SO14 0YG,UK.Tel.: +4 4 (0) 2380 825 533, Hospital,Graham Road, Southampton SO14 0YG,UK.Tel.: +44 (0) 238 0 825 533, fax: +44 (0) 238 0 234 243, email: dsb1 fax: +4 4 (0) 2380 234 243, email: dsb1@ @soton.ac.uk soton.ac.uk (First received 29 April 2005, final revision 23 February 2006, accepted 2 March 2006) (First received 29 April 2005, final revision 23 February 2006, accepted 2 March 2006) https://doi.org/10.1192/bjp.bp.105.012799 Published online by Cambridge University Press
Cited by
Sorted by citations
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090 · see citing works
“Similar evidence exists for paroxetine [546,547,553-558] supporting its use as a first-line option.”
BackgroundInfluentialFava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015) · Psychotherapy and Psychosomatics · doi:10.1159/000370338 · Cited by 421 · see citing works
Antidepressant discontinuation reactions: Are preventable and simple to treat
Haddad, P., Lejoyeux, M., & Young, A. (1998) · BMJ · doi:10.1136/bmj.316.7138.1105 · Cited by 286 · see citing works
McAllister-Williams, R. H., Arango, C., Blier, P., Demyttenaere, K., Falkai, P., Gorwood, P., Hopwood, M., Javed, A., Kasper, S., Malhi, G. S., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.02.023 · Cited by 278 · see citing works
Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., Rapee, R., & Wilkins, G. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867418799453 · Cited by 243 · see citing works
Rief, W., Nestoriuc, Y., von Lilienfeld-Toal, A., Dogan, I., Schreiber, F., Hofmann, S. G., Barsky, A. J., & Avorn, J. (2009) · Drug Safety · doi:10.2165/11316580-000000000-00000 · Cited by 202 · see citing works
The translational neural circuitry of anxiety
Robinson, O. J., Pike, A. C., Cornwell, B., & Grillon, C. (2019) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2019-321400 · Cited by 158 · see citing works
Gartlehner, G., Thieda, P., Hansen, R. A., Gaynes, B. N., DeVeaugh-Geiss, A., Krebs, E. E., & Lohr, K. N. (2008) · Drug Safety · doi:10.2165/00002018-200831100-00004 · Cited by 150 · see citing works
Systematic review and meta-analysis: dose-response curve of SSRIs and SNRIs in anxiety disorders
Jakubovski, E., Johnson, J. A., Nasir, M., Müller-Vahl, K., & Bloch, M. H. (2019) · Depression and Anxiety · doi:10.1002/da.22854 · Cited by 131 · see citing works
Gomez, A. F., Barthel, A. L., & Hofmann, S. G. (2018) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2018.1472767 · Cited by 125 · see citing works
Van Leeuwen, E., van Driel, M. L., Horowitz, M. A., Kendrick, T., Donald, M., De Sutter, A. I., Robertson, L., & Christiaens, T. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013495.pub2 · Cited by 90 · see citing works
Estimating Risk of Antidepressant Withdrawal from a Review of Published Data
Horowitz, M. A., Framer, A., Hengartner, M. P., Sørensen, A., & Taylor, D. (2023) · CNS Drugs · doi:10.1007/s40263-022-00960-y · Cited by 76 · see citing works
Agomelatine in Generalized Anxiety Disorder: An Active Comparator and Placebo-Controlled Study
Stein, D. J., Ahokas, A., Márquez, M. S., Höschl, C., Oh, K. S., Jarema, M., Avedisova, A. S., Albarran, C., & Olivier, V. (2014) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13m08433 · Cited by 67 · see citing works
Hoertel, N., Le Strat, Y., Blanco, C., Lavaud, P., & Dubertret, C. (2012) · Depression and Anxiety · doi:10.1002/da.21937 · Cited by 61 · see citing works
Meta-analysis: Risk of dry mouth with second generation antidepressants
Cappetta, K., Beyer, C., Johnson, J. A., & Bloch, M. H. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.12.012 · Cited by 49 · see citing works
Incidence and Nature of Antidepressant Discontinuation Symptoms
Kalfas, M., Tsapekos, D., Butler, M., McCutcheon, R. A., Pillinger, T., Strawbridge, R., Bhat, B. B., Haddad, P. M., Cowen, P. J., Howes, O. D., et al. (2025) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2025.1362 · Cited by 42 · see citing works
Self-citationAntidepressants, withdrawal, and addiction; where are we now?
Jauhar, S., Hayes, J., Goodwin, G. M., Baldwin, D. S., Cowen, P. J., & Nutt, D. J. (2019) · Journal of Psychopharmacology · doi:10.1177/0269881119845799 · Cited by 31 · see citing works
Self-citationSafer, D. J. (2016) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000564 · Cited by 19 · see citing works
Antidepressants versus placebo for generalised anxiety disorder (GAD)
Kopcalic, K., Arcaro, J., Pinto, A., Ali, S., Barbui, C., Curatoli, C., Martin, J., & Guaiana, G. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012942.pub2 · Cited by 16 · see citing works
Seo, H.-J., Song, H. R., Jeong, S., Kim, J.-B., Lee, M.-S., Kim, J.-M., Yim, H. W., & Jun, T.-Y. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.09.037 · Cited by 13 · see citing works
Emergence of Electric Shock-Like Sensations on Escitalopram Discontinuation
Prakash, O., & Dhar, V. (2008) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3181727534 · Cited by 5 · see citing works
- Authors
- Baldwin, D. S., Huusom, A. K. T., & Mæhlum, E.
- Affiliations
- Royal South Hants Hospital (GB)
- Lundbeck (Denmark) (DK)
- Corresponding author
- Baldwin, David S.
- ORCID
- Baldwin, David S.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2006-09
- Volume
- 189
- Issue
- 3
- Pages
- 264-272
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2018098567
- Semantic Scholar
- 7987b337cb7b2a5b04e36a97786cba82883ec91a
- Cited by
- 114
- References
- 28
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 2 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 6 · 2016: 4 · 2015: 4 · 2014: 4 · 2013: 7 · 2012: 7
- FWCI
- 14.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- generalized anxiety disorder, escitalopram, paroxetine, selective serotonin reuptake inhibitors, dose comparison, antidepressant efficacy, adverse events, treatment withdrawal
- MeSH terms
- Adult, Aged, Anxiety Disorders, Double-Blind Method, Female, Humans, Male, Middle Aged, Citalopram, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Paroxetine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
