Escitalopram reduces anxiety and depression in patients with CHD

Patients with coronary heart disease reported reduced anxiety and depression symptoms when taking escitalopram compared with those who exercised or took a placebo, according to findings published in JAMA Psychiatry.

“Anxiety disorders are particularly prevalent among patients with coronary heart disease (CHD) and are associated with greater mortality in healthy individuals and patients with CHD. Despite compelling reasons for treating anxiety in patients with CHD, few studies have examined the effects of treating anxiety in patients with cardiac disease, and no studies have examined the effects of treating anxiety on CHD biomarkers of risk, which could represent potential biological pathways to improve clinical outcomes,” James A. Blumenthal, PhD, a professor in the department of psychiatry and behavior sciences at Duke University School of Medicine, and colleagues wrote. “The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients With Coronary Heart Disease (UNWIND) trial was designed to examine the effects of escitalopram and aerobic exercise compared with placebo on anxiety and CHD biomarkers of risk in patients with stable CHD and elevated symptoms of anxiety.”

In a randomized clinical trial, Blumenthal and colleagues analyzed data from 128 patients older than 40 years with stable CHD and a diagnosed anxiety disorder or a Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) score of eight or higher (29% women; mean age, 64.6 years; 71% white; 29% African American; 8% other). All participants were sedentary and not receiving mental health treatment. Researchers measured participants’ anxiety in a tertiary care teaching hospital in the U.S. between January 2016 and May 2020.

Researchers randomly assigned participants to exercise, escitalopram or placebo in a 2:2:1 ratio.

The exercise group completed 12 weeks of aerobic exercises, and those who took escitalopram were given up to 20 mg a day or the placebo equivalent.

Participants’ HADS-A score served as the primary outcome. The researchers also observed CHD biomarkers such as heart rate variability, baroreflex sensitivity and flow-mediated dilation, in addition to 24-hour urinary catecholamines.

The participants randomly assigned to exercising and taking escitalopram experienced reduced HADS-A scores (exercise, 4; 95% CI, 4.7 to 3.2; escitalopram, 5.7; 95% CI, 6.4 to 5) compared with those randomly assigned to placebo (3.5; 95% CI, 4.5 to 2.4). However, those who received escitalopram reported less anxiety compared with those who exercised (1.67; 95% CI, 2.68 to 0.66).

Regarding CHD biomarkers, researchers found significant postintervention group differences in 24-hour urinary catecholamines (exercise z score = 0.05; 95% CI, 0.2 to 0.3; escitalopram z score = 0.24; 95% CI, 0.4 to 0; placebo z score = 0.36; 95% CI, 0 to 0.7), with greater reductions in the exercise group and escitalopram group compared with the placebo group and greater reductions in the escitalopram group compared with the exercise group.

While treatment with escitalopram was safe and effective for lowering anxiety in patients with CHD, exercise did not have a consistent impact on anxiety symptoms. Additionally, neither exercise nor escitalopram improved CHD biomarkers of risk.

“These findings show that escitalopram is safe and effective in reducing anxiety in cardiac patients with high anxiety,” Blumenthal told Healio. “Although exercise was effective in reducing ‘state’ anxiety (‘how are you feeling at this moment’), it was no better than a placebo in reducing ‘trait’ anxiety (‘how are you feeling in general’).”