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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Phillipa on March 19, 2009, at 18:40:30
Can't believe this study as older adults are called that at 41 years old so that makes me ancient. Ickkk. Love Phillipa
ADAA 2009: Combination Therapy Effective in Treating Late-Life Anxiety
March 18, 2009 (Santa Ana Pueblo, New Mexico) For older patients with generalized anxiety disorder (GAD), combining a short course of cognitive-behavioral therapy (CBT) with a selective serotonin-reuptake inhibitor (SSRI) may provide optimal long-term treatment.Preliminary findings from a study presented here at the Anxiety Disorders Association of America 2009 Annual Conference showed that a maintenance regimen that combined CBT and the SSRI escitalopram (Lexapro, Forest Pharmaceuticals) was superior in preventing GAD relapse in older adults vs either treatment alone.
According to lead author of the study, Julie Loebach Wetherell, PhD, from the University of California, San Diego, previous research suggests that psychotherapy, although effective for treating depression in older patients, is not as effective in reducing anxiety in this patient population. However, the reason is unclear.
To answer this question, the investigators are conducting a multicenter, open-label trial with a planned accrual of 80 older patients with GAD. According to the trial protocol, all participants are initially treated with open-label escitalopram for 12 weeks (acute phase). Subjects then enter an add-on phase where they are randomized to 16 weeks of escitalopram alone or escitalopram combined with 16 sessions of individual CBT (combination phase).
Finally, the study subjects enter the maintenance phase, in which they are randomized to continued treatment with escitalpram for 28 weeks or tapered off escitalopram to placebo.
No Relapse in Combination Group
The psychotherapy component of the trial was specifically designed for geriatric patients and includes a number of both mandatory sessions (education sessions, relaxation training, cognitive therapy) as well as optional sessions as needed (sleep hygiene, exposure therapy).
To date, data are available on 28 patients (7 in each study cohort) who have completed the entire 56-week trial. Of these 28 participants, 67.9% were women and 42.9% had comorbid Illness (primarily panic disorder). The average age of onset of GAD was 41.2 years, indicating that these individuals had GAD for an average of 30 years.
The preliminary results show that none of the individuals treated with dual CBT and continued escitalopram relapsed, whereas 5 participants who did not receive CBT and were tapered to placebo relapsed. In the other 2 treatment groups (CBT, tapered to placebo; and escitalopram alone), 1 person in each group relapsed.
"Most of the people who do relapse do so in the first 3 months after withdrawing from the drug," said Dr. Wetherell. This suggests, she said, that clinicians should definitely schedule a 3-month follow-up appointment for any patient who decides to discontinue medication.
Reduced Cognitive Flexibility
Commenting on the study, Murray B. Stein, MD, from the University of California, San Diego, suggested that it is possible that psychotherapy may not be effective in treating anxiety in older patients due to reduced cognitive flexibility in this population.
"If people become less cognitively efficient as they get older, it is quite possible that older individuals with GAD have a reduced ability to engage some of the prefrontal cortical systems that modulate their activity. They are working so hard to tame that limbic system that it is tough to engage in using psychotherapy therapy. That may be 1 reason SSRIs are so effective," he said.
Dr. Wetherell and colleagues are planning a longer-term follow-up analysis of the data at 1 year that will include an examination of biomarkers of health and treatment-specific modulators.
The study was funded by the National Institute of Mental Health and Forest Laboratories.
Anxiety Disorders Association of America 2009 Annual Conference: Poster 118D. Presented March 14, 2009
Posted by Neal on March 19, 2009, at 23:10:49
In reply to Anxiety Conference Older Adults considered 41!!!!, posted by Phillipa on March 19, 2009, at 18:40:30
are you 42? . . . :-D
Posted by 10derHeart on March 20, 2009, at 0:25:16
In reply to Anxiety Conference Older Adults considered 41!!!!, posted by Phillipa on March 19, 2009, at 18:40:30
I think you might have....I see this:
"The average age of onset of GAD was 41.2 years, indicating that these individuals had GAD for an average of 30 years."
Unless there's another place where they actually give the ages of the people in the study, this is only talking about how long (on average) the 28 pts they have data on so far, have been suffering from GAD - 30 year average with onset at around 41 - so that would put them in their 70's, I believe.
Also, they use the term "geriatric patients." I think medicine generally considers that over age 65, but I could be wrong. Do you remember from nursing what at what age someone was considered 'geriatric?' Or maybe elderly? Of course, I think geriatrics as a specialty, is something that's really blossomed in the past 20-30 years, so not sure what they may have been teaching a while back.
What do you think?
Phillipa, you are not ick or ancient. You are YOU - and part of you is the age you are this moment. Life has taken you this far to this point in time so we could all know you! :-) You are the same age as my T. and he is involved, engaged, aware, interested in life in general, young at heart - and more. Your Ebay stuff, your biking (so impresses me!) your devotion to Babble and Babblers, and more stuff I'm sure I don't know anything about - are you kidding? Doesn't that count for something? I wish you could give yourself a break on the numerical age thing.
And what if you were "ancient," whatever that is...? 80? 85? 90? Some of the most amazing people I've ever known, met, read about, have been those ages. Just think what more you'll know and understand by then. The help and empathy you will have for folks with mental illness, just to name one thing. You sell yourself short over age, as I think I do over weight. I decide it defines me and means things it doesn't mean. I limit and label myself negatively, and get all hopeless about certain things, using, "being too fat, " as a reason.
I understand it's scary, believe me, I do. If I dwell on it, I can terrify myself I will drop dead from CAD or a stroke one day, because I am so unhealthy carrying excess weight. It's a awful train of thought, as you know I have that sweet 2-year old to be a grandma to, for many years to come, I hope and pray. I just try different techniques not to "go there." That thinking just harms my present and does nothing for my future.
Neither of us should be so rough on ourselves, ya' know?? You are so much more than your age!!
Posted by Phillipa on March 20, 2009, at 0:44:12
In reply to Perhaps you misread it? » Phillipa, posted by 10derHeart on March 20, 2009, at 0:25:16
10derheart sure hope I did I guess I'm freaking also as turn 63 oh no it's already. I've always defined myself with physical things running not sitting and finding myself more tired all the time. That was very sweet of you. It's almost 2am here now. And I was born at 3:10 am according to birth certificate. I would like 20 years back could you arrange it in babbleland? Seriously going to google geriatric and see what the age it. Still no way you could be fat. Not the way I picture you at all. Love Jan
Posted by Phillipa on March 20, 2009, at 0:47:49
In reply to Perhaps you misread it? » Phillipa, posted by 10derHeart on March 20, 2009, at 0:25:16
Yup you're right 65 and older. So what happened to 60 being the new 40? Night 10derHeart going to read til I drop. Love Jan
Posted by Phillipa on March 20, 2009, at 0:51:34
In reply to Re: Anxiety Conference Older Adults considered 41!!!! » Phillipa, posted by Neal on March 19, 2009, at 23:10:49
Neal yes tonight I'm 42. In my dreams anyway . Seems like 71 or so is the age of the study. Love Jan/Phillipa
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