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In Reply: The comments by Ms Schwan and Dr Hallberg highlight measurement and analytic issues in anxiety treatment research. In the study, escitalopram was superior to placebo in cumulative response for GAD in older adults. This primary outcome analysis used the Clinical Global Impression-Improvement scale. Our use of this scale was based on its global assessment of clinical response using all available clinical data, including rating scale data, the patient's report, and the rater's observations. It has clear cut points for a binary outcome such as response, and it had adequate interrater reliability in this study.

In the study, we examined several continuous measures as secondary outcomes using mixed-effects repeated measures analyses, which are considered to be optimal in maximizing power and accounting for missing data.¹ Escitalopram was superior to placebo in measures of worry severity and role function but not Hamilton Anxiety Rating Scale score. There is no consensus . . . [Full Text of this Article]

Eric J. Lenze, MD
lenzee@wustl.edu
Department of Psychiatry
Washington University School of Medicine
St Louis, Missouri

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RELATED LETTER

Escitalopram Treatment of Generalized Anxiety Disorder in Older Adults
Sofie Schwan and Pär Hallberg
JAMA. 2009;301(19):1987-1988.
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