Escitalopram Lowers Anxiety and Depression in Patients With Coronary Heart Disease

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Escitalopram was identified to be more efficient at lowering symptoms of anxiousness and depression compared with placebo amongst patients with coronary heart illness (CHD), but it did not enhance CHD biomarkers of danger, according to researchers who published the benefits of their randomized clinical trial in JAMA Psychiatry.

The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients With CHD (UNWIND) trial (ClinicalTrials.gov Identifier: NCT02516332) evaluated the effects of escitalopram, aerobic physical exercise, and placebo on anxiousness and CHD danger biomarkers in patients aged 40 years and older. This is the initially study to assess the effect of therapy for anxiousness on CHD biomarkers of danger and the initially randomized clinical trial to evaluate the efficacy of a selective serotonin reuptake inhibitor or aerobic physical exercise in the therapy of patients with CHD and improved levels of anxiousness.

Study participants had steady CHD and severity of anxiousness symptoms graded at least 8 on the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) or a major diagnosis of an anxiousness disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).  The researchers excluded people who had been at the moment getting mental wellness therapy and these who exercised at least 1 day per week.


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The researchers measured heart price variability, baroreflex sensitivity, endothelial function, and urinary catecholamines just before and right after the 12-week interventions.

The researchers randomly assigned participants to aerobic physical exercise of moderate to higher intensity (n=52), escitalopram (n=53), or placebo (n=23) for 12 weeks. The physical exercise situation involved working out 3 instances per week with 10 minutes of warm-up workout routines 35 minutes of walking, biking, or jogging at 70% to 85% of heart price reserve and 5 minutes of cool-down workout routines. In the escitalopram situation, participants took escitalopram 5 mg/d, with the dosage improved to 10 mg/d at week 2, 15 mg/d at week 3, and 20 mg/d at week 4 if there had been no substantial improvement in anxiousness.

Participants in the physical exercise group and the escitalopram group reported higher imply reductions in HADS-A scores (physical exercise, -4. escitalopram, -5.7) compared with these who received placebo (-3.5 P =.03). HADS-A scores for the escitalopram group had been decrease compared with the physical exercise group (-1.67 P =.002).

Significant postintervention group variations in 24-hour urinary catecholamines had been identified (physical exercise z score = .05 escitalopram z score = -.24 placebo z score = .36), with higher reductions reported in the physical exercise group and escitalopram group compared with the placebo group (F1,127 = 4.93 P =.01) and higher reductions in the escitalopram group compared with the physical exercise group (F1,127 = 4.37 P =.04).

Post-therapy variations in 24-hour heart price variability, baroreflex sensitivity, and flow-mediated dilation had been inconsistent across therapy groups.

“Treatment of anxiety with escitalopram was safe and effective for reducing anxiety in patients with CHD,” the researchers mentioned. “However, the beneficial effects of exercise on anxiety symptoms were less consistent. Exercise and escitalopram did not improve CHD biomarkers of risk, which should prompt further investigation of these interventions on clinical outcomes in patients with anxiety and CHD.”

The researchers mentioned that modifying the physical exercise prescription may well have enhanced the outcome for the patients in that group.

Reference

Blumenthal JA, Smith PJ, Jiang W, et al. Effect of exercise, escitalopram, or placebo on anxiety in patients with coronary heart disease. JAMA Psychiatry. Published on-line August 18, 2021. doi:10.1001/jamapsychiatry.2021.2236



Originally published in www.psychiatryadvisor.com

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