A Randomized, Controlled Trial of the Effectiveness of Cognitive–Behavioral Therapy and Sertraline versus a Waitlist Control Group for Anxiety Disorders in Older Adults

Schuurmans, Josien; Comijs, Hannie C.; Emmelkamp, P.M.G.; Gundy, Chad M.; Weijnen, Ingrid; Hout, Marcel van den; Dyck, Richard van

doi:10.1097/01.jgp.0000196629.19634.00

Cited by 87 publications

(68 citation statements)

References 26 publications

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“…Preliminary evidence suggests that antidepressants are effective in the treatment of GAD and PD in older Barrowclough et al [168] ( Gorenstein et al [169] ( Mohlman et al [160] ( Mohlman et al [160] ( Wetherell et al [172] ( Katz et al [156] (five pooled studies) populations. Citalopram, [82] sertraline, [155] and venlafaxine ER [156] have all demonstrated efficacy for reducing anxiety among elderly patients. Schuurmans et al [155] compared sertraline to CBT and waitlist controls for patients with GAD, PD, AG, and SOP.…”

Section: Treatment Efficacymentioning

confidence: 99%

“…Citalopram, [82] sertraline, [155] and venlafaxine ER [156] have all demonstrated efficacy for reducing anxiety among elderly patients. Schuurmans et al [155] compared sertraline to CBT and waitlist controls for patients with GAD, PD, AG, and SOP. Despite high attrition rates, both treatments led to improved anxiety and worry symptoms, but sertraline had a greater effect posttreatment and at 3-month follow up than CBT.…”

Section: Treatment Efficacymentioning

confidence: 99%

See 1 more Smart Citation

Anxiety disorders in older adults: a comprehensive review

Wolitzky-Taylor¹,

Castriotta²,

Lenze³

et al. 2010

Depress. Anxiety

548

398

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This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults. Depression and Anxiety 27:190-211, 2010.

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Section: Treatment Efficacymentioning

confidence: 99%

Section: Treatment Efficacymentioning

confidence: 99%

Anxiety disorders in older adults: a comprehensive review

Wolitzky-Taylor¹,

Castriotta²,

Lenze³

et al. 2010

Depress. Anxiety

548

398

View full text Add to dashboard Cite

show abstract

“…Recently, our research group completed the first randomized controlled trial (RCT) of the effectiveness of individual format CBT versus an SSRI (sertraline) for the treatment of late-life anxiety disorders (Schuurmans et al, 2006). Although both treatments resulted in statistically significant improvement in outcome scores, effect sizes (Cohen's d, calculated as (M pre-treatment -M post-treatment )/standard deviation pooled ;Cohen, 1988) for CBT were relatively small (posttreatment mean d = 0.34), whereas effect sizes for sertraline were in the large range (post-treatment mean d = 1.00).…”

Section: Introductionmentioning

confidence: 99%

Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders

Schuurmans

Comijs

Emmelkamp

et al. 2009

Int. Psychogeriatr.

Self Cite

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Background: Although anxiety disorders are prevalent in older adults, randomized controlled trials of treatment effectiveness for late-life anxiety are scarce and have focused primarily on the effectiveness of psychotherapeutic interventions. However, recent findings suggest that in some cases, pharmacological treatment may be more beneficial for late-life anxiety disorders. As yet, there have been no systematic studies investigating prognostic factors for the outcome of cognitive behavioral therapy (CBT) and pharmacotherapy for late-life anxiety. The objective of the present study was to study long-term treatment outcomes and to explore differential predictors for both short-term and long-term treatment outcomes of sertraline and CBT for late-life anxiety disorders.

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“…22 In the two sertraline studies in GAD, sertraline was dosed flexibly between 50 and 150 mg daily (mean dose at the end of treatment about 90 mg). In one study sertraline was started at 25 mg daily for 1 week to improve tolerance early in therapy, 23 and this acclimatisation period is also recommended by the manufacturer in the licensed use of sertraline in post-traumatic stress disorder, social anxiety disorder and panic disorder. 24 …”

Section: Sertralinementioning

confidence: 99%

Pilot of a randomised controlled trial of the selective serotonin reuptake inhibitor sertraline versus cognitive behavioural therapy for anxiety symptoms in people with generalised anxiety disorder who have failed to respond to low-intensity psychological treatments as defined by the National Institute for Health and Care Excellence guidelines

Buszewicz

Cape

Serfaty

et al. 2017

Health Technol Assess

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Background Generalised anxiety disorder (GAD) is common, causing unpleasant symptoms and impaired functioning. The National Institute for Health and Care Excellence (NICE) guidelines have established good evidence for low-intensity psychological interventions, but a significant number of patients will not respond and require more intensive step 3 interventions, recommended as either high-intensity cognitive behavioural therapy (CBT) or a pharmacological treatment such as sertraline. However, there are no head-to-head comparisons evaluating which is more clinically effective and cost-effective, and current guidelines suggest that treatment choice at step 3 is based mainly on patient preference. Objectives To assess clinical effectiveness and cost-effectiveness at 12 months of treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline compared with CBT for patients with persistent GAD not improved with NICE-defined low-intensity psychological interventions. Design Participant randomised trial comparing treatment with sertraline with high-intensity CBT for patients with GAD who had not responded to low-intensity psychological interventions. Setting Community-based recruitment from local Improving Access to Psychological Therapies (IAPT) services. Four pilot services located in urban, suburban and semirural settings. Participants People considered likely to have GAD and not responding to low-intensity psychological interventions identified at review by IAPT psychological well-being practitioners (PWPs). Those scoring ≥ 10 on the Generalised Anxiety Disorder-7 (GAD-7) anxiety measure were asked to consider involvement in the trial. Inclusion criteria Aged ≥ 18 years, a score of ≥ 10 on the GAD-7, a primary diagnosis of GAD diagnosed on the Mini International Neuropsychiatric Interview questionnaire and failure to respond to NICE-defined low-intensity interventions. Exclusion criteria Inability to participate because of insufficient English or cognitive impairment, current major depression, comorbid anxiety disorder(s) causing greater distress than GAD, significant dependence on alcohol or illicit drugs, comorbid psychotic disorder, received antidepressants in past 8 weeks or high-intensity psychological therapy in previous 6 months and any contraindications to treatment with sertraline. Randomisation Consenting eligible participants randomised via an independent, web-based, computerised system. Interventions (1) The SSRI sertraline prescribed in therapeutic doses by the patient’s general practitioner for 12 months and (2) 14 (± 2) CBT sessions delivered by high-intensity IAPT psychological therapists in accordance with a standardised manual designed for GAD. Main outcome measures The primary outcome was the Hospital Anxiety and Depression Scale – Anxiety component at 12 months. Secondary outcomes included measures of depression, social functioning, comorbid anxiety disorders, patient satisfaction and economic evaluation, collected by postal self-completion questionnaires. Results Only seven internal pilot participants were recruited against a target of 40 participants at 7 months. Far fewer potential participants were identified than anticipated from IAPT services, probably because PWPs rarely considered GAD the main treatment priority. Of those identified, three-quarters declined participation; the majority (30/45) were reluctant to consider the possibility of randomisation to medication. Limitations Poor recruitment was the main limiting factor, and the trial closed prematurely. Conclusions It is unclear how much of the recruitment difficulty was a result of conducting the trial within a psychological therapy service and how much was possibly a result of difficulty identifying participants with primary GAD. Future work It may be easier to answer this important question by recruiting people from primary care rather than from those already engaged in a psychological treatment service. Trial registration Current Controlled Trials ISCRTN14845583. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 45. See the NIHR Journals Library website for further project information.

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A Randomized, Controlled Trial of the Effectiveness of Cognitive–Behavioral Therapy and Sertraline versus a Waitlist Control Group for Anxiety Disorders in Older Adults

Cited by 87 publications

References 26 publications

Anxiety disorders in older adults: a comprehensive review

Anxiety disorders in older adults: a comprehensive review

Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders

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