Pattern of Symptom Improvement Following Treatment With Venlafaxine XR in Patients With Generalized Anxiety Disorder
J Clin Psychiatry 2001;62(11):888-893
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The efficacy of anxiolytic drugs in
generalized anxiety disorder (GAD) is conventionally assessed by
evaluating changes in the total score of psychometric scales such
as the Hamilton Rating Scale for Anxiety (HAM-A). The purpose of
this pooled analysis of data was to evaluate the efficacy of
venlafaxine extended release (XR) on individual items of the
HAM-A and the Brief Scale for Anxiety (BSA).
Method: Data were pooled from 5 studies of
patients with GAD who were treated with either venlafaxine XR or
placebo for 8 weeks (N = 2021) and up to 6 months (N = 767).
Individual items of the HAM-A and the BSA were examined, and,
using the mean changes from baseline to endpoint, an effect size
for each item was calculated by dividing the difference between
baseline and endpoint values for each item by the standard
deviation of this difference. The effect sizes determined for the
venlafaxine group were compared with those for the placebo group.
Items from each scale that are concordant with the DSM-IV
diagnostic criteria for GAD were selected for further
examination, and the specific effect sizes of each item were
expressed after controlling for placebo effects.
Results: The effect size of the majority of the
14 items of the HAM-A scale and the 10 items of the BSA scale
associated with treatment with venlafaxine XR was greater than
with placebo at both 8 weeks and 6 months. Furthermore, the
effect sizes at 6 months were generally greater than at 8 weeks
in venlafaxine XR-treated patients. Effect sizes associated with
venlafaxine XR were greatest for the HAM-A items that were most
closely related to diagnostic symptoms of GAD, namely anxious
mood, tension, intellectual functioning, and behavior at
interview at both 8 weeks and 6 months. Similarly, GAD-related
BSA items of inner tension, worrying over trifles, hostile
feelings, and muscular tension were associated with the greatest
improvements with venlafaxine XR at both timepoints.
Conclusion: The HAM-A and BSA items that most
closely corresponded to DSM-IV diagnostic criteria for GAD showed
the largest improvement during treatment with venlafaxine XR.
This indicates that the specific symptoms of GAD can be treated
effectively with venlafaxine XR, both in the short and longer