Tuesday, November 12, 2019

Anxiety in Older Adults With MDD on Venlafaxine Doesn’t Reduce Chance of Remission, Study Finds

The presence of comorbid anxiety symptoms does not appear to predict the likelihood that older patients with major depressive disorder (MDD) will respond to the antidepressant venlafaxine, according to a study in Depression & Anxiety.

“[R]emission of depression was just as likely in more and less anxious participants,” Yasmina M. Saade, M.D., of Washington University in St. Louis and colleagues wrote.

Previous studies show that older depressed adults with comorbid anxiety often have more severe depression symptoms and cognitive decline and are at greater risk of suicide compared with older depressed adults without anxiety. To examine whether comorbid anxiety influences response to treatment in older adults, Saade and colleagues analyzed data from the Incomplete Response in Late‐Life Depression: Getting to Remission (IRL‐GRey) study, a large prospective antidepressant trial.

For the first phase of the IRL-GRey study, 468 adults aged 60 years or older with MDD received open‐label treatment with venlafaxine extended release, a selective serotonin and norepinephrine reuptake inhibitor. The participants were started at a dose of 37.5 mg/day and titrated up to 300 mg/day if they did not go into remission. Those who were taking a previously prescribed low-dose benzodiazepine were permitted to continue its use. Before starting on venlafaxine, the researchers evaluated the participants using Montgomery-Åsberg Depression Rating Scale (MADRS), the Brief Symptom Inventory anxiety subscale (BSI‐anxiety), the 19‐item Scale for Suicide Ideation (SSI), the Anxiety Sensitivity Index (ASI), and the Penn State Worry Questionnaire (PSWQ). The participants were reassessed using the MADRS, BSI-anxiety, and SSI weekly or biweekly throughout the 12- to 14-week open-label phase.

Baseline anxiety scores did not predict the likelihood of the participants’ remission of depressive symptoms (defined as a MADRS score ≤10 at both of the final two consecutive visits) on venlafaxine, the authors wrote. Similarly, the baseline anxiety scores did not predict time to remission. Participants who expressed some suicidality at baseline, however, tended to have more severe symptoms of depression and anxiety.

“In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission,” Saade and colleagues wrote. “The presence of comorbid anxiety should prompt an intensive course of treatment, including frequent follow‐up visits and maximizing the antidepressant dosage before declaring nonresponse. We also speculate that the use of a dual‐reuptake inhibitor may be preferable in depression with comorbid anxiety symptoms.”

For related information, see the American Journal of Psychiatry article “Norepinephrine Transporter Gene Variants and Remission From Depression With Venlafaxine Treatment in Older Adults.”

Pfizer contributed venlafaxine extended-release capsules for this study.

(Image: Alexander Raths/Shutterstock)

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