Key result
At 1-year follow-up, escitalopram significantly reduced anxiety (HADS-A score) compared to exercise (P=0.006), while there was no significant difference between the active treatments and placebo.
Why the study?
Anxiety is common among patients with coronary heart disease and is associated with a worse prognosis.
Does escitalopram or aerobic exercise reduce anxiety and depression symptoms at 1-year follow-up in patients with stable coronary heart disease and baseline anxiety?
RCT (n=128)
Blinded to treatment condition for psychiatrist
Parallel group
No
Does escitalopram or aerobic exercise reduce anxiety and depression symptoms at 1-year follow-up in patients with stable coronary heart disease and baseline anxiety?
Escitalopram provides sustained, safe, and effective relief from anxiety and depression for at least one year in patients with stable CHD, whereas structured exercise does not appear to improve anxiety outcomes.
Answers are grounded in this paper and cite their sources.
Escitalopram reduced anxiety more than exercise at 1 year in stable CHD; challenges exercise as an effective intervention while leaving placebo-controlled superiority unresolved.
Anxiety is common among patients with coronary heart disease (CHD) and is associated with a worse prognosis. UNWIND was a 12-week randomized clinical trial comparing exercise and escitalopram to placebo on measures of anxiety, depression, and CHD biomarkers. Primary results of the trial reported that treatment with escitalopram, but not exercise, was associated with significant reductions in anxiety and depression. At 1-year follow-up, participants completed the Hospital Anxiety-Depression Scale-Anxiety (HADS-A) along with the HADS-Depression (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Godin Leisure Time Exercise survey to assess physical activity. Results showed that those patients randomized to escitalopram had lower scores on the HADS-A compared to those randomized to exercise (P = 0.006) and had less depression compared to exercise on the HADS-D (P = 0.004) and BDI-II (P = 0.004). Participants randomized to exercise reported higher levels of physical activity at 1-year compared to those randomized to Placebo (P = 0.039). However, despite reporting being more physically active, those randomized to exercise did not have less anxiety or depression compared to placebo controls. Escitalopram appears to be a safe and effective treatment for anxiety; exercise has many health benefits, but does not appear to be effective in treating anxiety.
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Blumenthal et al. (2022) conducted an RCT in Stable coronary heart disease with anxiety (n=128). Escitalopram vs. Aerobic Exercise (and Placebo) was evaluated on Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score at 1-year follow-up (p=0.006). At 1-year follow-up, escitalopram significantly reduced anxiety (HADS-A score) compared to exercise (P=0.006), while there was no significant difference between the active treatments and placebo.
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