Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T15:01:43.315Z Has data issue: false hasContentIssue false
  • English
  • Français

Analysis of the Rate of Improvement of Specific Psychic and Somatic Symptoms of General Anxiety Disorder During Long-Term Treatment with Venlafaxine ER

Published online by Cambridge University Press:  07 November 2014

Stephen M. Stahl ,
Saeeduddin Ahmed  and
Vincent Haudiquet
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: Generalized anxiety disorder (GAD) is a chronic illness with psychic and somatic symptoms that do not respond uniformly in the first weeks of treatment.

Methods: A post-hoc analysis of pooled data from five placebo-controlled, double-blind, randomized studies in non-depressed GAD patients treated with venlafaxine extended release (ER) or placebo was performed to determine the temporal response of psychic and somatic symptoms to treatment over 8 weeks. Two of the studies included extension phases of up to 6 months, the results of which were also analyzed here.

Results: The earliest symptoms to respond included both psychic symptoms (anxious mood, tension, behavior at interview) and somatic muscular, cardiovascular, and respiratory symptoms. The last symptoms to respond included the psychic symptoms of insomnia and fear and the somatic sensory, gastrointestinal and autonomic symptoms, perhaps in part because of drug-related side effects. Continuing treatment beyond 8 weeks in venlafaxine ER responders for up to 6 months of total treatment results not only in additional improvement in early-responding symptoms, but also in the improvement of late-responding symptoms, perhaps due in part to the development of tolerance to antidepressant side effects.

Conclusion: Serious consideration should be given to maintaining partial responders to venlafaxine ER treatment on the same treatment for ≥3–6 months.

Type
Original Research
Information
CNS Spectrums , Volume 12 , Issue 9 , September 2007 , pp. 703 - 711
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Yonkers, KA, Warshaw, MG, Massion, AO, Keller, MB. Phenomenology and course of generalised anxiety disorder. Br J Psychiatry. 1996;168:308–313.CrossRefGoogle ScholarPubMed
2.Grant, BF, Hasin, DS, Stinson, FS, et al.Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2005;35:1747–1759.CrossRefGoogle ScholarPubMed
3.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
4.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
5.Maier, W, Gansicke, M, Freyberger, HJ, Linz, M, Heun, R, Lecrubier, Y. Generalized anxiety disorder (ICD-10) in primary care from a cross-cultural perspective: a valid diagnostic entity? Acta Psychiatr Scand. 2000;101:29–36.CrossRefGoogle ScholarPubMed
6.Yonkers, KA, Dyck, IR, Warshaw, M, Keller, MB. Factors predicting the clinical course of generalised anxiety disorder. Br J Psychiatry. 2000;176:544–549.CrossRefGoogle ScholarPubMed
7.Hoehn-Saric, R, McLeod, DR, Zimmerli, WD. Symptoms and treatment responses of generalized anxiety disorder patients with high versus low levels of cardiovascular complaints. Am J Psychiatry. 1989;146:854–859.Google ScholarPubMed
8.Tyrer, PJ, Lader, MH. Response to propranolol and diazepam in somatic and psychic anxiety. Br Med J. 1974;2:14–16.CrossRefGoogle ScholarPubMed
9.Rickels, K, Weisman, K, Norstad, N, et al.Buspirone and diazepam in anxiety: a controlled study. J Clin Psychiatry. 1982;43(12 pt 2):81–86.Google ScholarPubMed
10.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.CrossRefGoogle ScholarPubMed
11.Rickels, K, Zaninelli, R, McCafferty, J, Bellew, K, Iyengar, M, Sheehan, D. Paroxetine treatment of generalized anxiety disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2003;160:749–756.CrossRefGoogle ScholarPubMed
12.Ballenger, JC. Remission rates in patients with anxiety disorders treated with paroxetine. J Clin Psychiatry. 2004:65:1696–1707.CrossRefGoogle ScholarPubMed
13.Rocca, P, Fonzo, V, Scotta, M, Zanalda, E, Ravizza, L. Paroxetine efficacy in the treatment of generalized anxiety disorder. Acta Psychiatr Scand. 1997:95:444–550.CrossRefGoogle ScholarPubMed
14.Pollack, MH, Zaninelli, R, Goddard, A, et al.Paroxetine in the treatment of generalized anxiety disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry. 2001;62:350–357.CrossRefGoogle ScholarPubMed
15.Stocchi, F, Nordera, G, Jokinen, RH, et al.Efficacy and tolerability of paroxetine for the long-term treatment of generalized anxiety disorder. J Clin Psychiatry. 2003;64:250–258.CrossRefGoogle ScholarPubMed
16.Ball, SG, Kuhn, A, Wall, D, Shekhar, A, Goddard, AW. Selective serotonin reuptake inhibitor treatment for generalized anxiety disorder: a double-blind, prospective comparison between paroxetine and sertraline. J Clin Psychiatry. 2005;66:94–99.CrossRefGoogle ScholarPubMed
17.Allgulander, C, Dahl, AA, Austin, C, et al.Efficacy of sertraline in a 12-week trial for generalized anxiety disorder. Am J Psychiatry. 2004;161:1642–1649.CrossRefGoogle Scholar
18.Davidson, JR, Bose, A, Korotzer, A, Zheng, H. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety. 2004;19:234–240.CrossRefGoogle ScholarPubMed
19.Sheehan, DV. Venlafaxine extended release (XR) in the treatment of generalized anxiety disorder. J Clin Psychiatry. 1999;60:23–28.Google ScholarPubMed
20.Allgulander, C, Hackett, D, Salinas, E. Venlataxine extended release (ER) in the treatment of generalised anxiety disorder: twenty-four-week placebo-controlled dose-ranging study. Br J Psychiatry. 2001;179:15–22.CrossRefGoogle Scholar
21.Gelenberg, AJ, Lydiard, RB, Rudolph, RL, Aguiar, L, Haskins, JT, Salinas, E. Efficacy of venlafaxine extended-release capsules in nondepressed outpatients with generalized anxiety disorder: a 6-month randomized controlled trial. JAMA. 2000;283:3082–3088.CrossRefGoogle ScholarPubMed
22.Montgomery, SA, Sheehan, DV, Meoni, P, Haudiquet, V, Hackett, D. Characterization of the longitudinal course of improvement in generalized anxiety disorder during long-term treatment with venlafaxine XR. J Psychiatr Res. 2002;36:209–217.CrossRefGoogle ScholarPubMed
23.Pollack, MH, Meoni, P, Otto, MW, 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 Psychopharmacol. 2003;23:250–259.CrossRefGoogle ScholarPubMed
24.Meoni, P, Hackett, D, Lader, M. Pooled analysis of venlafaxine XR efficacy on somatic and psychic symptoms of anxiety in patients with generalized anxiety disorder. Depress Anxiety. 2004;19:127–132.CrossRefGoogle ScholarPubMed
25.Kelsey, JE. Efficacy, safety, and tolerability of venlafaxine XR in generalized anxiety disorder. Depress Anxiety. 2000;12:81–84.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
26.Meoni, P, Salinas, E, Brault, Y, Hackett, D. Pattern of symptom improvement following treatment with venlafaxine XR in patients with generalized anxiety disorder. J Clin Psychiatry. 2001;62:888–893.CrossRefGoogle ScholarPubMed
27.Stahl, SM, Grady, MM, Moret, C, Briley, M. SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants. CNS Spectr. 2005;10:732–747.CrossRefGoogle ScholarPubMed
28.Lipman, R, Covi, L. Outpatient treatment of neurotic depression: medication and group psychotherapy. In: Spitzer, RL, Klein, DL, eds. Evaluation of the Psychological Therapies. Baltimore, Md: Johns Hopkins University Press; 1976;178–218.Google Scholar
29.Rickels, K, Pollack, MH, Sheehan, DV, Haskins, JT. Efficacy of extended-release venlafaxine in nondepressed outpatients with generalized anxiety disorder. Am J Psychiatry. 2000;157:968–974.CrossRefGoogle ScholarPubMed
30.Raskin, A, Schulterbrandt, JG, Reatig, N. Rater and patient characteristics associated with rater differences in psychiatric scale ratings. J Clin Psychol. 1966;22:417–423.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
31.Mitte, K, Noack, P, Steil, R, Hautzinger, M. A meta-analytic review of the efficacy of drug treatment in generalized anxiety disorder. J Clin Psychopharmacol. 2005;25:141–150.CrossRefGoogle ScholarPubMed
32.Trivedi, MH, Rush, AJ, Wisniewski, SR, et al.Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163:28–40.CrossRefGoogle ScholarPubMed