Pregabalin reduces psychic and somatic symptoms of GAD in elderly patients.(Generalized Anxiety Disorder (GAD))(Clinical report)

Pregabalin (Lyrica) was found to be safe and effective in reducing psychic and somatic symptoms of generalized anxiety disorder (GAD) in elderly patients. In an 8-week double-blind, randomized, placebo-controlled trial, patients in the pregabalin group experienced decreased levels of anxiety regardless of their illness severity, with improvements already evident by the second week of treatment.

The study appears in the November 2008 issue of The British Journal of Psychiatry.

According to principal investigator, Stuart Montgomery, M.D. and colleagues, "The study is the first large, placebo-controlled pharmacological treatment study in elderly people with generalized anxiety disorder and it is reassuring to have convincing evidence of the efficacy of a treatment for adults of all ages." Montgomery is Emeritus Professor of Psychiatry, Imperial College of Medicine, University of London.

Background

Pregabalin is a novel compound and a precursor of the anticonvulsant gabapentin (Neurontin). Pregabalin is approved in the United States (US) as adjunctive treatment for partial seizures, as treatment for neuropathic pain from diabetes or shingles, and is the first drug approved by the US Food and Drug Administration (FDA) for treating fibromyalgia. Pregabalin received licensing approval in March 2007 from the European Commission for treatment of GAD, but is not currently approved in the US for that indication.

Montgomery and colleagues indicate that GAD may be the most common anxiety disorder in patients aged 55 years and older and, unlike other anxiety disorders, appears to have a later onset with up to 10% of cases of first onset occurring after age 50. In both younger and older adults, GAD has higher chronicity than major depression. At 12 years, GAD remission rates are approximately 42% in younger adults, and 31% at 6 years in older adults.

Benzodiazepines continue to be used as a first-line option for GAD. There is some evidence of greater efficacy with benzodiazepines in relieving somatic symptoms compared with selective serotonin reuptake inhibitors (SSRIs) and other types of antidepressants which appear to have greater efficacy in reducing psychic symptoms of GAD. Benzodiazepines carry associated risks, particularly in the elderly, of psychomotor, cognitive and memory impairment, and increased risks of injury due to falls.