Journal Mobile Options
Table of Contents
Vol. 82, No. 6, 2013
Issue release date: October 2013
Psychother Psychosom 2013;82:363-371
(DOI:10.1159/000351410)

Remission of Generalized Anxiety Disorder after 6 Months of Open-Label Treatment with Venlafaxine XR

Rickels K. · Etemad B. · Rynn M.A. · Lohoff F.W. · Mandos L.A. · Gallop R.
aMood and Anxiety Disorders Section, Department of Psychiatry, University of Pennsylvania School of Medicine, and bUniversity of the Sciences, Philadelphia, Pa., and cDepartment of Psychiatry, Columbia University, New York, N.Y., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: Remission has become one of the leading outcome criteria in clinical trials. Data collected by this research group assessed the rate of remission after 6 months of treatment of generalized anxiety disorder (GAD) with venlafaxine XR, to search for predictors of remission and to define how early on in treatment later remission can be predicted. Method: Two hundred sixty-eight patients with a GAD diagnosis enrolled into an open-label 6-month-treatment trial with venlafaxine XR (75-225 mg/day). Remission was defined by a Hamilton anxiety scale total score ≤7. Logistic regression approaches were used to find out how early on in treatment later remission could be predicted, as well as to determine predictors of remission. In addition, adverse events were also followed over time. Results: While the total enrolled patient sample (n = 268) had a remission rate of 53%, 6-month completers (n = 159) had a remission rate of 79%. The only statistically significant predictor of remission, independent of baseline anxiety and depression levels, was a low Eysenck neuroticism score. The remission status outcome could best be predicted after 8 weeks of treatment when a CGI-I score of 1 or 2 predicted later remission with 78% accuracy and later nonremission with 91% accuracy. The incidence of adverse events decreased over the 6-month period, with sexual adverse events decreasing the least. Conclusion: The only significant predictor of remission was a low score on the Eysenck neuroticism scale. The earliest reliable prediction of later remission, based on improvement, could be made after 8 weeks of treatment with 91% accuracy.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Ballenger JC: Clinical guidelines for establishing remission in patients with depression and anxiety. J Clin Psychiatry 1999;60(suppl 22):29-34.

    External Resources

  2. Rickels K, Rynn M, Iyengar M, Duff D: Remission of generalized anxiety disorder: a review of the paroxetine clinical trials database. J Clin Psychiatry 2006;67:41-47.

    External Resources

  3. Pollack HM, Meoni P, Otto WM, Hackett D: Predictors of outcome following venlafaxine extended-release treatment of DSM-IV generalized anxiety disorder: a pooled analysis of short- and long-term studies. J Clin Psychopharm 2003;23:250-259.

    External Resources

  4. Allgulander C, Florea I, Huusom AK: Prevention of relapse in generalized anxiety disorder by escitalopram treatment. Int J Neuropsychopharmacol 2006;9:495-505.
  5. Rickels K, Etemad B, Khalid-Khan S, Lohoff FW, Rynn MA, Gallop RJ: Time to relapse after 6 and 12 months' treatment of generalized anxiety disorder with venlafaxine extended release. Arch Gen Psychiatry 2010;67:1274-1281.
  6. Kahn RJ, McNair DM, Lipman RS, Covi L, Rickels K, Downing R, Fisher S, Frankenthaler LM: Imipramine and chlordiazepoxide in depressive and anxiety disorders. 2. Efficacy in anxious outpatients. Arch Gen Psychiatry 1986;43:79-85.
  7. Rickels K, Downing R, Schweizer E, Hassman H: Antidepressants for the treatment of generalized anxiety disorder: a placebo-controlled comparison of imipramine, trazodone and diazepam. Arch Gen Psychiatry 1993;50:884-895.
  8. First MB, Spitzer RL, Gibbon M, Williams JB: Structured clinical Interview for Axis I DSM-IV Disorders (version 2.0). New York, New York State Psychiatric Institute, 1996.
  9. Hamilton MA: the assessment of anxiety status by rating. Br J Med Psychol 1959;32:50-55.
  10. Guy W (ed): ECDEU Assessment Manual for Psychopharmacology: Revised. Rockville, National Institute of Mental Health, 1976.
  11. Hamilton MA: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
  12. Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-370.
  13. Sheehan DV, Harnett-Sheehan K, Raj BA: The measurement of disability. Int Clin Psychopharmacol 1996;11(suppl 3):89-95.
  14. Meyer TJ, Miller ML, Metzger RL, Borkovec TD: Development and validation of the Penn State worry questionnaire. Behav Res Ther 1990;28:487-495.
  15. Bech P: Rating Scales for Psychopathology, Health Status and Quality of Life. New York, Springer, 1993, pp 402-404.
  16. Eysenck HJ: Manual of the Maudsley Personality Inventory. London, University of London Press, 1959.
  17. Kraemer HC, Bloch DA: Kappa coefficients in epidemiology: an appraisal of a reappraisal. J Clin Epidemiol 1988;41:959-968.
  18. Zweig MH, Campbell G: Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993;39:561-577.

    External Resources

  19. Porock D, Parker-Oliver D, Petroski GF, Rantz M: The MDS mortality risk index: the evolution of a method for predicting 6-month mortality in nursing home residents. BMS Res Notes 2010;3:1-8.
  20. Altman DG, Andersen PK: Bootstrap investigation of the stability of a Cox regression model. Stat Med 1989;8:771-783.
  21. Sauerbrei W: The use of re-sampling methods to simplify regression models in medical statistics. Appl Statist 1999;48:313-329.

    External Resources

  22. Moret C, Isaac M, Briley M: Review: problems associated with long-term treatment with selective serotonin reuptake inhibitors. J Psychopharmacol 2009;23:967-974.
  23. Shea MT, Pilkonis PA, Beckham E, Collins JF, Elkin I, Sotsky SM, Docherty JP: Personality disorders and treatment outcome in the NIMH treatment of depression collaborative research program. Am J Psychiatry 1990;147:711-718.

    External Resources

  24. Joffee RT, Regan JJ: Personality and response to tricyclic antidepressants in depressed patients. J Nerv Ment Dis 1989;177:745-749.
  25. Diguer L, Barber JP, Luborsky L: Three concomitants: personality disorders, psychiatric severity, and outcome of dynamic psychotherapy of major depression. Am J Psychiatry 1993;150:1246-1248.

    External Resources

  26. Rickels K, Downing RW, Case GW, Csanalosi I, Chung H, Winokur A, Gingrich R: Six-week trial with diazepam: some clinical observations. J Clin Psychiatry 1985;46:470-474.

    External Resources

  27. Stein MK, Downing RW, Rickels K: The Minnesota multiphase personality inventory in predicting response to pharmacotherapy of neurotic outpatients. J Nerv Ment Dis 1979;167:542-547.

    External Resources

  28. Massion AO, Dyck IR, Shea MT, Phillips KA, Warsaw MG, Keller MB: Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Arch Gen Psychiatry 2002;59:434-440.
  29. Rickels K, Schweizer E, Case GW, García-España F: Benzodiazepine dependence, withdrawal severity, and clinical outcome: effects of personality. Psychopharmacol Bull 1988;24:415-420.

    External Resources

  30. Schweizer E, Rickels K, De Martinis N, Case G, García-España F: The effect of personality on withdrawal severity and taper outcome in benzodiazepine dependent patients. Psychol Med 1998;28:713-720.

    External Resources

  31. Cuijpers P, Smit F, Penninx BW, de Graaf R, ten Have M, Beekman AT: Economic costs of neuroticism. Arch Gen Psychiatry 2010;67:1086-1093.
  32. Rickels K (ed): Non-Specific Factors in Drug Therapy. Springfield, Thomas, 1968.
  33. Rickels K, Schweizer E, Csanalosi I, Case WG, Chung H: Long term treatment of anxiety and risk of withdrawal: prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry 1988;45:444-450.
  34. Fava GA: Statistical alchemy for drug treatment of generalized anxiety disorder: a commentary on the meta-analysis by Baldwin et al. (BMJ 2011;342:d1199). Psychother Psychosom 2011;80:261-263.
  35. Berney P, Halperin D, Tango R, Daenicker-Dayer I, Schulz P: A major change of prescribing pattern in absence of adequate evidence: benzodiazepines versus newer antidepressants in anxiety disorder. Psychopharmacol Bull 2008;41:39-47.

    External Resources

  36. Fava GA, Offidani E: The mechanism of tolerance in antidepressant action. Prog Neuropsuchopharmacol Biol Psychiatry 2011;35:1593-1602.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50