This R01 resubmission from a new principal investigator focuses on generalized anxiety disorder (GAD) in elderly persons, a significant public health issue because of the high prevalence and burden of GAD in this age group. However, the treatment evidence in late life GAD is inadequate, and the illness remains vastly under treated. This study is a 12 week randomized, double-blind, placebo-controlled examination of escitalopram, an SSRI that is well-tolerated and highly specific for the serotonin transporter (SERT). We will recruit 176 subjects aged 60 and older from primary care practices for treatment. Subjects will have GAD without current major depressive disorder. The study will allow inclusion of comorbidity commonly seen in anxious elderly, including depression. We will examine symptomatic response. As secondary, exploratory analyses, we will examine treatment-attributable changes in functional disability and neuropsychological measures. We will genotype subjects in terms of a SERT polymorphism which has been posited as a moderator of SSRI treatment outcome, and we will determine whether allelic variation in the SERT contributes to the variability of treatment response. Our first goal is to demonstrate SSRI efficacy for late life GAD in the primary care sector. It is our expectation that demonstration of medication efficacy in this population (and dissemination of the results) would lead to increased utilization of pharmacotherapy for this disorder. Efficacy evaluation will include examination of functional and neuropsychological improvements from treatment. The second goal is the examination of a genetic moderator of treatment response - such findings could lead not only to improvements in the individualization of treatment for late life GAD, but also to a greater understanding of the neurobiological sources of heterogeneity in this disorder.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH070547-06
Application #
7559700
Study Section
Special Emphasis Panel (ZMH1-NRB-G (12))
Program Officer
Evans, Jovier D
Project Start
2005-04-15
Project End
2011-01-31
Budget Start
2009-02-01
Budget End
2011-01-31
Support Year
6
Fiscal Year
2009
Total Cost
$295,455
Indirect Cost
Name
Washington University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Rodebaugh, Thomas L; Scullin, Rachel B; Langer, Julia K et al. (2016) Unreliability as a threat to understanding psychopathology: The cautionary tale of attentional bias. J Abnorm Psychol 125:840-51
Rosnick, Christopher B; Wetherell, Julie L; White, Kamila S et al. (2016) Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial. J Consult Clin Psychol 84:345-52
Garfield, Lauren D; Dixon, David; Nowotny, Petra et al. (2014) Common selective serotonin reuptake inhibitor side effects in older adults associated with genetic polymorphisms in the serotonin transporter and receptors: data from a randomized controlled trial. Am J Geriatr Psychiatry 22:971-9
Bryant, Christina; Mohlman, Jan; Gum, Amber et al. (2013) Anxiety disorders in older adults: looking to DSM5 and beyond... Am J Geriatr Psychiatry 21:872-6
Rodebaugh, Thomas L; Levinson, Cheri A; Lenze, Eric J (2013) A high-throughput clinical assay for testing drug facilitation of exposure therapy. Depress Anxiety 30:631-7
Lenze, Eric J; Dixon, David; Nowotny, Petra et al. (2013) Escitalopram reduces attentional performance in anxious older adults with high-expression genetic variants at serotonin 2A and 1B receptors. Int J Neuropsychopharmacol 16:279-88
Rosnick, Christopher B; Rawson, Kerri Sharp; Butters, Meryl A et al. (2013) Association of cortisol with neuropsychological assessment in older adults with generalized anxiety disorder. Aging Ment Health 17:432-40
Wetherell, Julie Loebach; Petkus, Andrew J; White, Kamila S et al. (2013) Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults. Am J Psychiatry 170:782-9
Lenze, Eric J; Dixon, David; Mantella, Rose C et al. (2012) Treatment-related alteration of cortisol predicts change in neuropsychological function during acute treatment of late-life anxiety disorder. Int J Geriatr Psychiatry 27:454-62
Andreescu, Carmen; Lenze, Eric J (2012) Comorbid anxiety and depression: bĂȘte noire or quick fix? Br J Psychiatry 200:179-81

Showing the most recent 10 out of 24 publications