WebMD Medical News
Louise Chang, MD
Jan. 20, 2009 -- Medication for anxiety is "modestly beneficial" for very anxious older adults, according to a new study, but it takes four weeks or so to work.
Researchers looked at one specific drug, Lexapro, part of a class known as selective serotonin reuptake inhibitors (SSRIs), to see if it could help relieve the symptoms of generalized anxiety disorder (GAD) in older adults. Those with the condition worry chronically and can't seem to stop, with their quality of life affected.
SSRIs are medications prescribed for both anxiety and depression and are thought to work by correcting an imbalance of the brain chemical serotonin.
"Although these medications have been examined in younger adults, there has been very little examination of them in older adults," says study researcher Eric J. Lenze, MD, associate professor of psychiatry at Washington University in St. Louis.
And the need is great, he says, with nearly one in 10 older adults affected by GAD.
Lenze and his colleagues assigned 85 adults with GAD (average age 71) to take Lexapro. Ninety-two adults with the condition (average age 72) were assigned to take placebo pills. The participants did not know what they were taking. The study lasted 12 weeks.
Lenze's team measured the participants' anxiety and other factors, such as social functioning and limitations in activity due to anxiety.
At the end of 12 weeks, 69% of those in the medication group had a response, compared to 51% in the placebo group, a difference that is considered significant. Those on Lexapro had more improvement in anxiety symptoms and their self-reported functioning, the researchers found.
But when the researchers considered the participants who dropped out, a more conservative way to analyze the findings, they found that the response rate was 57% for those who got the medicine and 45% for those on placebo -- not a significant difference.
"A short conclusion is that the drug was modestly beneficial, and even those modest benefits can only be seen if someone sticks with the medication long enough to see if it will help or not," Lenze says.
It took about four weeks for the benefits of the medication to become apparent, he says.
"In older people the drugs may take longer to work," Lenze says. "Patients need to be aware of that. They shouldn't expect immediate benefits."
The study was funded by a variety of sources, such as the National Institutes of Health. Forest Laboratories Inc., which makes Lexapro, provided both the drug and placebo but had no role in the study. The results are published in TheJournal of the American Medical Association.
"The data doesn't come as a surprise," says Philip Muskin, MD, a professor of clinical psychiatry at Columbia University College of Physicians and Surgeons and a psychiatrist in New York City, who reviewed the study for WebMD.
"Those who stayed on the drug and took it got better, and more [of them] got better than the placebo group," he says. The difference, he agrees, was modest.
The study had some other important findings, he says. "No one had really bad side effects" from the drug, he says. Fatigue or sleepiness were the most common side effects.
Generalized anxiety disorder "is a real illness," Muskin says. "And all real illness should be treated."
Those with GAD worry about the same kinds of things those without the condition worry about -- family, health, finances -- but they worry severely and for excessive amounts of time, Lenze says. "They have a full-time job worrying."
"It's the inability to put the worries out of your mind" that sets those with GAD apart, he says. "People with GAD have high levels of [the stress hormone] cortisol." Chronically high levels are hard on one's health, he says.
Besides medication, treatment can include cognitive behavior therapy, also known as "talk therapy," Lenze says. "Relaxation therapy can be effective at well."
Of GAD, Lenze says, "It's distressing and burdensome. [But] people can get help. It is a treatable problem."
SOURCES:Eric J. Lenze, MD, geriatric psychiatrist; associate professor of
psychiatry, Washington University School of Medicine, St. Louis.Lenze, E. The Journal of the American Medical Association, Jan. 21,
2009; vol 301: pp 295-303.Philip Muskin, MD, psychiatrist; professor of clinical psychiatry, Columbia
University College of Physicians and Surgeons, New York City.
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