Escitalopram appears to be more effective than exercise at reducing anxiety in patients with coronary heart disease, a study published today in JAMA Psychiatry has found.
“To our knowledge, [this study] is the first randomized clinical trial to evaluate the efficacy of a selective serotonin reuptake inhibitor or aerobic exercise in the treatment of anxiety in patients with [coronary heart disease] and high levels of anxiety,” wrote James A. Blumenthal, Ph.D., of Duke University Medical Center and colleagues. “Escitalopram produced clinically meaningful reductions in anxiety, as well as significant reductions in depression.”
Blumenthal and colleagues recruited men and women aged 40 years or older with coronary heart disease and anxiety symptoms (score of 8 or higher on the Hospital Anxiety and Depression-Anxiety Subscale, or HADS-A) and/or a DSM-5 primary diagnosis of an anxiety disorder for the trial. Patients were excluded if they had a primary psychiatric diagnosis other than an anxiety disorder, were currently receiving mental health treatment, and/or if they exercised regularly. A total of 128 participants were randomly assigned to aerobic exercise (three days a week), escitalopram (up to 20 mg a day), or a placebo pill for 12 weeks.
The researchers evaluated the patients using the Structured Clinical Interview for DSM-5 Disorders and the 14-item Hamilton Anxiety Rating Scale before and after the 12-week interventions. They also assessed the participants weekly using the Spielberger State-Trait Anxiety Inventory-State, which asks about the frequency of such feelings as “I am tense; I am worried.” Symptoms of depression (using the HADS depression subscale and Beck Depression Inventory-II) as well as heart rate variability, baroreflex sensitivity, and endothelial function—biomarkers for coronary heart disease—were also measured before and after the interventions.
Examination of HADS-A scores after 12 weeks revealed that all groups showed reduced levels of anxiety following treatment, with mean reductions of −4.0 in the exercise group, −5.7 in the escitalopram group, and −3.5 in the placebo group, Blumenthal and colleagues reported. Additional analysis revealed that participants in the escitalopram group had greater reductions in HADS-A scores compared with participants in the placebo group, while the exercise and placebo groups were not different.
“Although exercise achieved comparable reductions in state anxiety relative to escitalopram after 12 weeks and greater reductions compared with placebo controls, exercise did not result in lower anxiety scores compared with placebo on the HADS-A or on any of the supplemental trait anxiety measures,” the authors wrote. “There were no treatment-related differences in [coronary heart disease] biomarkers, so the clinical significance of these findings regarding potential cardiovascular benefits is unknown.”
For related information, see the chapter on heart disease in the book The American Psychiatric Association Publishing Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry.