Augmenting antidepressant medication with modular CBT for geriatric generalized anxiety disorder: a pilot study.
OBJECTIVE
Generalized anxiety disorder (GAD) is a prevalent psychiatric condition in older adults with deleterious effects on health and cognition. Although selective serotonin reuptake inhibitor (SSRI) medications have some efficacy as acute treatments for geriatric GAD, incomplete response is the most common outcome of monotherapy. We therefore developed a novel sequential treatment strategy, using personalized, modular cognitive-behavioral therapy (mCBT) to augment SSRI medication.


METHODS
In an open label pilot study (N = 10), subjects received a sequenced trial of 12 weeks of escitalopram followed by 16 weeks of escitalopram augmented with mCBT. We also examined the maintenance effects of mCBT over a 28-week follow-up period following drug discontinuation and termination of psychotherapy.


RESULTS
Results suggest that (1) adding mCBT to escitalopram significantly reduced anxiety symptoms and pathological worry, resulting in full remission for most patients and (2) some patients maintained response after all treatments were withdrawn.


CONCLUSIONS
Findings suggest that mCBT may be an effective augmentation strategy when added to SSRI medication and provide limited support for the long-term benefit of mCBT after discontinuation of pharmacotherapy.
Wetherell
Julie Loebach
JL
VA San Diego Healthcare System, San Diego, California, USA; Department of Psychiatry, University of California, San Diego, La Jolla, California, USA. jwetherell@ucsd.edu
Stoddard
Jill A
JA
White
Kamila S
KS
Kornblith
Sander
S
Nguyen
Hoang
H
Andreescu
Carmen
C
Zisook
Sidney
S
Lenze
Eric J
EJ
D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods; D015283:Citalopram / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors