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Augmenting antidepressant medication with modular CBT for geriatric generalized anxiety disorder: a pilot study
Julie Loebach Wetherell1, Jill A Stoddard, Kamila S White
1VA San Diego Healthcare System, San Diego, California, USA; Department of Psychiatry, University of California, San Diego, La Jolla, California, USA. jwetherell@ucsd.edu
International Journal of Geriatric Psychiatry
|September 28, 2010
Summary
Adding modular cognitive-behavioral therapy (mCBT) to escitalopram significantly improved anxiety and worry in older adults with generalized anxiety disorder (GAD), with many achieving remission.
Area of Science:
- Geriatric psychiatry
- Clinical psychology
- Pharmacotherapy
Background:
- Generalized anxiety disorder (GAD) is common in older adults, impacting health and cognition.
- Selective serotonin reuptake inhibitors (SSRIs) offer limited efficacy as monotherapy for geriatric GAD, with incomplete response being frequent.
- A novel sequential treatment augmenting SSRI medication with personalized, modular cognitive-behavioral therapy (mCBT) was developed.
Purpose of the Study:
- To evaluate the efficacy of mCBT as an augmentation strategy for SSRI treatment in older adults with GAD.
- To assess the maintenance effects of mCBT after discontinuation of medication and psychotherapy.
Main Methods:
- An open-label pilot study involved 10 subjects.
- Participants underwent a 12-week trial of escitalopram, followed by 16 weeks of escitalopram combined with mCBT.
- A 28-week follow-up examined treatment maintenance post-discontinuation.
Main Results:
- Augmenting escitalopram with mCBT significantly reduced anxiety symptoms and pathological worry.
- Most patients achieved full remission of GAD symptoms.
- Some patients maintained treatment response after discontinuing all interventions.
Conclusions:
- Modular cognitive-behavioral therapy (mCBT) shows promise as an effective augmentation strategy for SSRI treatment in geriatric GAD.
- Limited evidence suggests potential long-term benefits of mCBT even after pharmacotherapy cessation.
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