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Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder.
J Clin Psychiatry. 2010 Feb; 71(2):121-9.JC

Abstract

OBJECTIVE

Analyses of data from 4 relapse-prevention studies with escitalopram were conducted in order to compare patients with and without residual symptoms with regard to relapse rates and global illness during double-blind, 24-week continuation periods.

METHOD

Clinical Global Impressions-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization.

RESULTS

All studies showed a statistically significant (P < .0001) standardized effect size of about 0.7 for escitalopram versus placebo, with a number needed to treat approximately 4. Patients with residual symptoms (MADRS score > 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill than patients without such a symptom. Patients who did not continue active treatment worsened, even if they were initially free of a residual symptom. In contrast, patients who continued receiving escitalopram remained stable or further improved, regardless of residual symptoms or diagnosis. No clear picture emerged regarding whether patients with residual symptoms had a higher relapse rate.

CONCLUSIONS

The presence of residual symptoms is associated with significantly worse overall illness severity in all 4 diagnostic groups and with a higher (although not significantly) risk of relapse for patients with MDD or OCD. The greatest difference in all of the studies was between patients treated with escitalopram (relapse rates ~ 20%) and placebo (relapse rates of about 50%).

Authors+Show Affiliations

Psychiatric Research Unit, Frederiksborg General Hospital, Dyrehavevej 48, DK-3400 Hillerød, Denmark. pebe@noh.regionh.dkNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

19961809

Citation

Bech, Per, et al. "Relapse Prevention and Residual Symptoms: a Closer Analysis of Placebo-controlled Continuation Studies With Escitalopram in Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Obsessive-compulsive Disorder." The Journal of Clinical Psychiatry, vol. 71, no. 2, 2010, pp. 121-9.
Bech P, Lönn SL, Overø KF. Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder. J Clin Psychiatry. 2010;71(2):121-9.
Bech, P., Lönn, S. L., & Overø, K. F. (2010). Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 71(2), 121-9. https://doi.org/10.4088/JCP.08m04749blu
Bech P, Lönn SL, Overø KF. Relapse Prevention and Residual Symptoms: a Closer Analysis of Placebo-controlled Continuation Studies With Escitalopram in Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Obsessive-compulsive Disorder. J Clin Psychiatry. 2010;71(2):121-9. PubMed PMID: 19961809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder. AU - Bech,Per, AU - Lönn,Sara L, AU - Overø,Kerstin F, Y1 - 2009/12/01/ PY - 2008/09/23/received PY - 2009/01/02/accepted PY - 2009/12/8/entrez PY - 2009/12/8/pubmed PY - 2010/4/23/medline SP - 121 EP - 9 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 71 IS - 2 N2 - OBJECTIVE: Analyses of data from 4 relapse-prevention studies with escitalopram were conducted in order to compare patients with and without residual symptoms with regard to relapse rates and global illness during double-blind, 24-week continuation periods. METHOD: Clinical Global Impressions-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization. RESULTS: All studies showed a statistically significant (P < .0001) standardized effect size of about 0.7 for escitalopram versus placebo, with a number needed to treat approximately 4. Patients with residual symptoms (MADRS score > 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill than patients without such a symptom. Patients who did not continue active treatment worsened, even if they were initially free of a residual symptom. In contrast, patients who continued receiving escitalopram remained stable or further improved, regardless of residual symptoms or diagnosis. No clear picture emerged regarding whether patients with residual symptoms had a higher relapse rate. CONCLUSIONS: The presence of residual symptoms is associated with significantly worse overall illness severity in all 4 diagnostic groups and with a higher (although not significantly) risk of relapse for patients with MDD or OCD. The greatest difference in all of the studies was between patients treated with escitalopram (relapse rates ~ 20%) and placebo (relapse rates of about 50%). SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/19961809/Relapse_prevention_and_residual_symptoms:_a_closer_analysis_of_placebo_controlled_continuation_studies_with_escitalopram_in_major_depressive_disorder_generalized_anxiety_disorder_social_anxiety_disorder_and_obsessive_compulsive_disorder_ L2 - http://www.psychiatrist.com/jcp/article/pages/2010/v71n02/v71n0203.aspx DB - PRIME DP - Unbound Medicine ER -