Anxiety impairs depression remission in partial responders during extended treatment in late-life

Authors

  • Adam Greenlee B.A.,

    1. Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Jordan F. Karp M.D.,

    Corresponding author
    1. Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. John A. Hartford Center of Excellence in Geriatric Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    3. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    4. Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    • Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Mailing Address: 3811 O'Hara Street, Courier/Office: 100 North Bellefield Avenue, Room ♯766, Pittsburgh, PA 15213
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  • Mary Amanda Dew Ph.D.,

    1. Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    3. Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
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  • Patricia Houck M.S.H.,

    1. Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Carmen Andreescu M.D.,

    1. John A. Hartford Center of Excellence in Geriatric Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Charles F. Reynolds III M.D.

    1. Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. John A. Hartford Center of Excellence in Geriatric Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    3. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract

Objectives: More than half of older adults with major depressive disorder require extended treatment because of incomplete response during acute treatment. This study characterizes the effect of anxiety on remission during extended treatment for partial responders. Methods: Following 6 weeks of escitalopram 10 mg/day+depression care management (DCM), 124 partial responders (Hamilton Rating Scale for Depression (HRSD) scores of 11–14) were randomly assigned to receive extended treatment with escitalopram 20 mg/day+DCM with or without interpersonal psychotherapy (IPT) for 16 weekly sessions. Remission was defined as three consecutive weekly scores ≤7 on the HRSD. We assessed concurrent symptoms of anxiety using the Hamilton Rating Scale for Anxiety at pretreatment and after 6 weeks. We conducted Cox regression analysis of time to remission and logistic modeling of rates of remission. We also explored whether anxiety severity altered any impact of IPT. Results: Pretreatment anxiety was not associated with time to or rates of remission during 16 weeks of extended treatment. In contrast, more severe psychological symptoms of anxiety after 6 weeks of treatment was associated with both longer time to and lower rates of remission. However, there was no evidence that IPT showed any differential effects as a function of anxiety. Conclusions: In partial responders to 6 weeks of lower-dose escitalopram and DCM, planning for extended treatment should account for psychological symptoms of anxiety. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.

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