Early response and 8-week treatment outcome in GAD

Abstract

Our objective was to compare the predictive value of early response to treatment outcome in patients with generalized anxiety disorder (GAD) treated with benzodiazepines, serotonin receptor (5HT-1A) partial agonists, or placebo. Data from two double-blind GAD studies were combined. Subjects were evaluated with the Hamilton Anxiety Scale (HAM-A) and the Clinical Global Impression of Improvement (CGI-I) scale over 8 weeks. Categories of response at weeks 1 and 2 were defined by the HAM-A total score. Analyses of covariance and Kaplan-Meier survival analyses were the primary analyses used to assess 8-week end point treatment outcomes as a function of early improvement. HAM-A change from baseline to weeks 1 and 2 significantly predicted last observation carried forward (LOCF) response at week 8 for both medications and for placebo (P<.001). Early improvement was a strong predictor for treatment outcome irrespective of whether active medication or placebo was the treatment agent.

How long should a trial of escitalopram treatment be in patients with major depressive disorder, generalised anxiety disorder or social anxiety disorder? An exploration of the randomised controlled trial database

“…An onset of effect within the first 2 weeks of treatment for GAD has been associated with greater likelihood of overall response at study end-point, for diazepam (Downing and Rickels, 1985), buspirone or lorazepam (Laakmann et al, 1998) and benzodiazepines, azapirones or placebo (Rynn et al, 2006).…”

Early Response to Psychotherapy and Long-Term Change in Worry Symptoms in Older Adults With Generalized Anxiety Disorder

“…In a study of 396 adults with GAD (mean age = 41), initial response to medication (defined by score change on the Hamilton Anxiety Scale after the first and second weeks of treatment) predicted 8-week treatment outcome. (23) In another pharmacologic trial for GAD, response and remission rates also varied systematically as a function of score change in the first 2 weeks of treatment. (24) It is unknown whether a similar phenomenon occurs in psychotherapy for GAD and whether the effect of early response is specific to worry.…”

Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement

“…With alliance and symptoms only measured at later time points, the directionality of effects is temporally confounded, potentially obscuring changes occurring early in therapy that are highly clinically relevant (Feeley, DeRubeis, & Gelfand, 1999). This dearth of research is particularly surprising, given the association between common factors and early treatment improvement in adults (Lambert, 2005) and the finding that early improvement in treatment is frequently associated with better long-term outcomes (Cromley & Lavigne, 2008; Delgadillo et al, 2013; Rynn, Khalid-Khan, Garcia-Espana, Etemad, & Rickels, 2006). …”