Posted by Phillipa on March 19, 2009, at 18:40:30
Can't believe this study as older adults are called that at 41 years old so that makes me ancient. Ickkk. Love Phillipa
ADAA 2009: Combination Therapy Effective in Treating Late-Life Anxiety
March 18, 2009 (Santa Ana Pueblo, New Mexico) For older patients with generalized anxiety disorder (GAD), combining a short course of cognitive-behavioral therapy (CBT) with a selective serotonin-reuptake inhibitor (SSRI) may provide optimal long-term treatment.Preliminary findings from a study presented here at the Anxiety Disorders Association of America 2009 Annual Conference showed that a maintenance regimen that combined CBT and the SSRI escitalopram (Lexapro, Forest Pharmaceuticals) was superior in preventing GAD relapse in older adults vs either treatment alone.
According to lead author of the study, Julie Loebach Wetherell, PhD, from the University of California, San Diego, previous research suggests that psychotherapy, although effective for treating depression in older patients, is not as effective in reducing anxiety in this patient population. However, the reason is unclear.
To answer this question, the investigators are conducting a multicenter, open-label trial with a planned accrual of 80 older patients with GAD. According to the trial protocol, all participants are initially treated with open-label escitalopram for 12 weeks (acute phase). Subjects then enter an add-on phase where they are randomized to 16 weeks of escitalopram alone or escitalopram combined with 16 sessions of individual CBT (combination phase).
Finally, the study subjects enter the maintenance phase, in which they are randomized to continued treatment with escitalpram for 28 weeks or tapered off escitalopram to placebo.
No Relapse in Combination Group
The psychotherapy component of the trial was specifically designed for geriatric patients and includes a number of both mandatory sessions (education sessions, relaxation training, cognitive therapy) as well as optional sessions as needed (sleep hygiene, exposure therapy).
To date, data are available on 28 patients (7 in each study cohort) who have completed the entire 56-week trial. Of these 28 participants, 67.9% were women and 42.9% had comorbid Illness (primarily panic disorder). The average age of onset of GAD was 41.2 years, indicating that these individuals had GAD for an average of 30 years.
The preliminary results show that none of the individuals treated with dual CBT and continued escitalopram relapsed, whereas 5 participants who did not receive CBT and were tapered to placebo relapsed. In the other 2 treatment groups (CBT, tapered to placebo; and escitalopram alone), 1 person in each group relapsed.
"Most of the people who do relapse do so in the first 3 months after withdrawing from the drug," said Dr. Wetherell. This suggests, she said, that clinicians should definitely schedule a 3-month follow-up appointment for any patient who decides to discontinue medication.
Reduced Cognitive Flexibility
Commenting on the study, Murray B. Stein, MD, from the University of California, San Diego, suggested that it is possible that psychotherapy may not be effective in treating anxiety in older patients due to reduced cognitive flexibility in this population.
"If people become less cognitively efficient as they get older, it is quite possible that older individuals with GAD have a reduced ability to engage some of the prefrontal cortical systems that modulate their activity. They are working so hard to tame that limbic system that it is tough to engage in using psychotherapy therapy. That may be 1 reason SSRIs are so effective," he said.
Dr. Wetherell and colleagues are planning a longer-term follow-up analysis of the data at 1 year that will include an examination of biomarkers of health and treatment-specific modulators.
The study was funded by the National Institute of Mental Health and Forest Laboratories.
Anxiety Disorders Association of America 2009 Annual Conference: Poster 118D. Presented March 14, 2009
poster:Phillipa
thread:886130
URL: http://www.dr-bob.org/babble/20090313/msgs/886130.html