By Mary Beth Nierengarten
SANTA ANA PUEBLO, NM -- March 17, 2009 -- Treating generalised anxiety disorder (GAD) in older patients with selective serotonin reuptake inhibitors (SSRIs) provides beneficial effects on stress and health, researchers reported here at the Anxiety Disorders Association of America (ADAA) 29th Annual Conference.
According to investigator Eric J. Lenze, MD, Department of Psychiatry, Washington University, St. Louis, Missouri, and colleagues, the reduced symptoms of anxiety in these older patients were accompanied by reduced levels of cortisol and blood pressure.
The study's original results were reported in the January issue of the Journal of the American Medical Association.(1) Their study randomised 85 patients to 12 weeks of escitalopram 10 to 20 mg/day and 92 patients to placebo. All patients were at least 60 years of age (mean 71 years) and had a diagnosis of GAD.
The published results showed that patients treated with escitalopram had a significantly higher cumulative response rate compared with placebo (69% vs 51%, P = .04). However, the differences between the treatment groups were not very large and were not seen until after 6 weeks of treatment.
To understand better the possible effect of GAD treatment on biological markers of stress and health in this older cohort, Dr. Lenze and colleagues assessed the effects on blood levels of cortisol and on blood pressure over 12 weeks in the patients treated with escitalopram versus placebo.
Presenting the new findings on March 14, Dr. Lenze reported that patients treated with escitalopram had a much greater decline in cortisol blood levels than those on placebo. They also found a greater reduction in blood pressure in patients treated with escitalopram compared with placebo.
Although these findings suggest a benefit of treating older patients with SSRIs, Dr. Lenze emphasised the need for long-term data on the overall efficacy and safety of SSRIs in older patients.
One question raised by these results is whether reducing cortisol levels may help reduce cognitive decline in these older patients based on data that show increased cortisol levels in people with mild dementia, the researchers noted.(2)
"Increased cortisol in anxiety may be driving cognitive problems," said Dr. Lenze, adding that a question remains answered: whether the acute effects of treatment on biomarkers of stress and health translate into a long-term cognitive benefit.
1. Lenze EJ et al. JAMA. 2009;301:295-303.
2. Csernansky JG et al. Am J Psychiatry. 2006;163:2164-2169.
[Presentation title: Pharmacotherapy of Generalized Anxiety Disorder in Older Adults. Abstract 118C]
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