Artigo Científico

Resumo:

Generalized anxiety disorder (GAD) is a prevalent anxiety disorder (2.7% point prevalence in the United States) noted for its hallmark symptom, excessive worry. GAD is more common in individuals undergoing maintenance hemodialysis (HD) and has been associated with worse health outcomes.1 However, the importance of co-occurring anxiety in HD patients with major depressive disorder remains understudied.2 The ASCEND (A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression) trial3,4 compared the efficacy of cognitive behavioral therapy (CBT) with sertraline drug therapy for the treatment of depression (major depressive disorder or dysthymia) in patients undergoing maintenance HD. The study found that depressive symptoms and other patient-reported outcomes improved with both treatments. The outcome scores at 12 weeks were modestly better with sertraline but with higher incidence of mild and moderate severity adverse events. The original study also reported substantive reduction in anxiety as measured by GAD-75 with both treatments, with no significant differences between the two groups (effect size estimate −1.2, 95% confidence interval [CI], −3.1 to 0.8). Prespecified analyses to determine whether the baseline severity of anxiety symptoms modified the response to treatment of depression among participants enrolled in the ASCEND study are presented.