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Anxiety symptom severity and functional recovery or relapse

Dan J. Stein, MD, PhD

Department of Psychiatry, University of Cape Town, Cape Town, South Africa, Mt. Sinai School of Medicine, New York, NY, USA

Borwin Bandelow, MD

Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany

Ornah T. Dolberg, MD

H. Lundbeck A/S Copenhagen, Denmark

Henning F. Andersen, MSc

Novo Nordisk A/S Bagsværd, Denmark

David S. Baldwin, MD

Clinical Neuroscience Division, School of Medicine, University of Southampton, Southampton, United Kingdom

BACKGROUND: Anxiety disorders are associated with significant disability. There is growing interest in the question of whether pharmacotherapy that effectively reduces symptoms can also restore function. Recovery could potentially be defined as a lack of disability, with an associated reduction in symptom severity. Conversely, relapse could potentially be defined in terms of either increased disability or increased symptoms.

METHODS: We analyzed a database of randomized controlled trials of escitalopram in generalized anxiety disorder (GAD) and social anxiety disorder (SAD), focusing on the relationship between disorder-specific severity scales, and the Sheehan Disability Scale (SDS). In short-term studies, cut-points on symptom scales were derived for recovered function. In relapse prevention studies, the effects of defining relapse in terms of increased disability scores were examined.

RESULTS: In GAD and SAD, there is a close correlation between primary symptom severity scales and the SDS, both in the short term and during relapse prevention. Thus, functional recovery is associated with relatively low symptom severity scores, and rates of relapse—defined in terms of increased disability—are significantly lower on escitalopram than on placebo.

CONCLUSIONS: These data indicate that recovery and relapse can potentially be defined either in terms of symptom severity or functioning. Thus, the concept of functional recovery and relapse may be useful in defining treatment outcomes. Longer-term treatment of anxiety disorders is needed to ensure functional recovery.

KEYWORDS: generalized anxiety disorder, social anxiety disorder, Sheehan Disability Scale, recovery


CORRESPONDENCE Dan J. Stein, MD, PhD, Department of Psychiatry, University of Cape Town, Groote Schuur Hospital (J-2), Anzio Rd., Observatory 7925, Cape Town, South Africa. E-MAIL:
Annals of Clinical Psychiatry ©2009 American Academy of Clinical Psychiatrists

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