Efficacy and Safety of Escitalopram in Alleviating Depression and Anxiety Symptoms in COPD Patients: A Randomized...

Depression and anxiety negatively impact COPD prognosis, yet evidence for psychopharmacological interventions remains limited. This study evaluated the efficacy and safety of low-dose escitalopram for managing these comorbidities in COPD patients.

In this double-blind, placebo-controlled trial, 150 COPD patients with moderate-to-severe anxiety and/or depression were randomized (1:1) to receive escitalopram (5-10 mg/day) or placebo for 4 weeks, followed by an 11-month observational follow-up without maintenance study medication. Primary endpoints were changes in HAMA-14 and HAMD-17 scores at Month 1. Secondary outcomes included CAT scores, mMRC ratings, and lung function (FEV₁% predicted) through Month 12.

At Month 1, escitalopram demonstrated significantly greater reductions in HAMA-14 (-9.25 [95% CI -9.67 to -8.82] vs -2.20 [-2.46 to -1.95]) and HAMD-17 (-7.37 [-7.74 to -7.01] vs -1.37 [-1.72 to -1.01]) compared to placebo (p < 0.01). These improvements were sustained at Month 12 (p < 0.01). CAT scores improved significantly more in the escitalopram group (-6.20 [-6.68 to -5.72]) versus placebo (-2.79 [-3.02 to -2.55]) over the 12-month observational period (p < 0.01). No significant differences were observed for mMRC or FEV₁% predicted. Adverse events were mild and comparable between groups.

Short-term treatment with low-dose escitalopram significantly alleviates depression and anxiety in COPD patients. Notably, this brief intervention initiated a sustained positive clinical trajectory over 12 months. Combined with a favorable safety profile, these findings support its potential integration into comprehensive COPD management protocols, pending multicenter validation.

ChiCTR1800017338 (https://www.chictr.org.cn/). Registered 25-July-2018.