Escitalopram for the treatment of GAD: efficacy across different subgroups and outcomes.
BACKGROUND
Generalized anxiety disorder (GAD) is characterized by anxiety, and also frequently associated with depressive symptoms. Benzodiazepines have commonly been used in the treatment of GAD, but are not effective antidepressant agents. In this study, we determined whether the selective serotonin reuptake inhibitor escitalopram, was effective across different subgroups and outcomes (anxious symptoms, depressive symptoms, and quality of life).


METHODS
Three randomized, placebo controlled studies of escitalopram in GAD have employed a similar design, allowing for pooling of the data. The primary efficacy measure was the Hamilton Anxiety Scale (HAMA). General linear models were used to determine the efficacy of escitalopram across different subgroups and outcomes.


RESULTS
Escitalopram was efficacious for GAD on a range of measures of both anxiety and depression, and improved the associated impairment in quality of life. There was no significant interaction of effects on the HAMA with demographic or clinical variables. Furthermore, escitalopram was efficacious on both primary and secondary scales in the subgroup of subjects with above-median severity of depressive symptoms at baseline (HAMD-17 > 12).


CONCLUSIONS
Escitalopram reduces anxiety and depressive symptoms in GAD, and improves quality of life. It is equally effective in GAD patients, with an above-median level of depressive symptoms. Further research is needed to determine whether these results can be extrapolated to GAD patients with comorbid major depression.
Stein
Dan J
DJ
University of Stellenbosch, Department of Psychiatry, P.O. Box 19063, Tygerberg, 7505, South Africa.
Andersen
Henning Friis
HF
Goodman
Wayne K
WK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D001008:Anxiety Disorders / Q000188:drug therapy*; D015283:Citalopram / Q000627:therapeutic use*; D003863:Depression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D015283:Citalopram; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors