Outcomes of Late-Life Anxiety Disorders During 32 Weeks of Citalopram Treatment

Stephen Blank, B.A.; Eric J. Lenze, M.D.; Benoit H. Mulsant, M.D.; Mary Amanda Dew, Ph.D.; Jordan F. Karp, M.D.; M. Katherine Shear, M.D.; Patricia R. Houck, M.S.; Mark D. Miller, M.D.; Bruce G. Pollock, M.D., Ph.D.; Barbara Tracey, M.S.N.; and Charles F. Reynolds III, M.D.

Background: Anxiety disorders are common in later life, but little is known about the long-term benefits and risks of pharmacotherapy.

Method: 30 patients aged 60 years and older, with a DSM-IV anxiety disorder, entered a 32-week trial of citalopram. Data gathered at baseline and follow-up included anxiety symptoms using Hamilton Rating Scale for Anxiety (HAM-A) scores, quality of life using the Medical Outcomes Study 36-item Short Form (SF-36), and sleep using the Pittsburgh Sleep Quality Index (PSQI). Data analysis consisted of mixed-effect repeated measures models of HAM-A scores and pre-post comparison of SF-36 and PSQI scores.

Results: 30 persons entered treatment; most (27/30) had a primary DSM-IV diagnosis of generalized anxiety disorder (2 had panic disorder; 1 had posttraumatic stress disorder). Three subjects discontinued study medication due to side effects, 5 were terminated because of nonresponse, and 5 dropped out of the study for other reasons; thus, 17 subjects (57%) completed 32 weeks of treatment. Subjects' HAM-A scores improved significantly, with continuing improvements up until about 20 weeks of treatment. On the basis of a criterion of reduction in HAM-A to < 10 during the trial, 60% (18/30) of subjects were responders. Those who completed the 32-week trial had significant improvements in sleep and quality of life-including social functioning, vitality, mental health, and role difficulties due to emotional problems.

Conclusions: In this 32-week study of citalopram for elderly persons with anxiety disorders, 60% responded. Those who received a full course of treatment experience significant improvements in quality of life and sleep quality.

(J Clin Psychiatry 2006;67:468-472)

Received May 25, 2005; accepted Aug. 15, 2005. From the Intervention Research Center for Late-Life Mood Disorders, the Department of Psychiatry, University of Pittsburgh School of Medicine (all authors), and the VA Pittsburgh Health Care System (Dr. Mulsant), Pittsburgh, Pa.

Supported by an investigator-initiated grant from Forest Laboratories, Inc., New York, N.Y. (Dr. Lenze), and by National Institute of Mental Health grants K23 MH 64196, P30 MH 52247, and T32 MH8619986.

Drs. Lenze, Mulsant, Karp, Shear, Miller, Pollock, and Reynolds have received honoraria and/or grant support from or served as a speaker/ consultant for Forest Pharmaceuticals and the following antidepressant manufacturers: Astra-Zeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Organon, Pfizer, Sepracor, and Wyeth. Mr. Blank, Dr. Dew, and Mss. Houck and Tracey report no other financial disclosure relevant to the subject of this article.

Corresponding author and reprints: Eric J. Lenze, M.D., Western Psychiatric Institute and Clinic Room E1124, 3811 O'Hara St., Pittsburgh, PA 15213 (e-mail: lenzeej@msx.upmc.edu).