What the trial was testing
The UNWIND enrolled 128 patients with anxiety. The study was sponsored by Duke University and tracked outcomes across the full group of patients who matched the trial's eligibility profile.
Researchers followed patients through treatment and into recovery, tracking the outcomes that mattered most for the disease being studied.
What the results showed
Escitalopram lowered anxiety scores 5.7 points — about double exercise.
JAMA Psychiatry · 2021 · NCT02516332
These findings — that anxiety score on escitalopram vs. inactive comparison in coronary heart disease — were published in the JAMA Psychiatry and represent the headline result of the study.
Researchers tracked outcomes across 128 patients enrolled in the trial. The result was consistent enough across the group that the team felt confident reporting it.
What this means for patients
For patients with anxiety, this result changes the calculus on what to ask their care team about. Whether it changes day-to-day care depends on factors like disease subtype, prior treatments, and where the patient is in their care journey.
What you can do now
Escitalopram (Lexapro) is FDA-approved and available now as a once-daily generic pill. It is one of the first-line treatments for anxiety disorders. Aerobic exercise is also good for the heart and mood, even if anxiety relief was modest in this study. Ask a primary care doctor or psychiatrist about a plan that includes both.
Eligibility for the treatments mentioned above depends on specific test results and clinical history. Bring this summary, the trial name, and your most recent labs or pathology report to your next visit.
Open anxiety trials
The Short-term Effects of PRISMA on Mental Health
Given the high prevalence of mental health issues, such as anxiety and depression, in pretrial detainees, the Swiss Federal Justice Department (SFJD) approved a model trial ("Modellversuch Untersuchungshaft", MV). The MV will be carried out in 11 pretrial detention facilities in the cantons of Zurich and Bern and aims to improve the wellbeing and social integration of individuals in pretrial detention. As part of the MV the investigators are evaluating the impact of two interventions using a randomized controlled trial (RCT). The first intervention, "Prison Stress Management" (PRISMA), addresses the issue of poor mental health of inmates during pretrial detention and after release. PRISMA is a scalable World Health Organization (WHO)-developed psychological intervention based on cognitive-behavioral therapy (CBT) program and goes beyond the status-quo mental health support offered in jails. Currently, only inmates with severe mental health problems are referred to the psychiatric ward of the health services provided in jails and no continuation of support is offered after the transition to the outside world. The second intervention (SOCIAL) uses extended social services to address potential disruptions incarceration might cause in detainees' social and economic lives. The isolation from the outside world implies that detainees might lose their jobs and housing, their relationships with their family and friends are strained, all factor hindering re-integration into society and taxing their mental wellbeing. This project will provide much needed insights to criminal justice authorities to design detention facilities and the detention experience in ways that empower incarcerated individuals to cope with the disruptions and psychological stress that come along with their detention.
Detection of Hoarding Disorder and Related Psychopathology
Hoarding disorder is characterized by excessive amassment of objects in the home and difficulty of getting rid of the objects. It is associated with a high level of somatic and psychiatric comorbidity, suicidality, social marginalization, damage to property and risk of eviction. Previous clinical studies have mainly been in help-seeking groups. However, social services engage severe cases with poor insight, whereas few as 10% have contact with mental health services. This study investigates: 1. The prevalence of severe mental illness and comorbidities among 60 individuals with hoarding disorder that have led to contact with social services at Copenhagen Municipality 2. the effect of a cross-sectoral intervention aiming to establish contact with regional mental health services for these individuals. The intervention consists of an outreach team of clinicians and municipal social workers who refer participants to clinical services based on a systematic clinical assessment. Primary outcomes are 1) primary and comorbid diagnoses assigned at the clinical assessment and 2) contact with mental health services after the intervention, at 3- and 6-months follow-up. Six to 12 months after the baseline assessment, a qualitative follow-up interview will be carried out, including approximately 14 participants. The aim is to explore the participants' experience of the intervention and subsequent clinical and social services to provide a more nuanced understanding of the quantitative outcomes of the study. The hypotheses of the study are 1. more than 75% of the participants will be identified to have comorbid diagnoses including more than 50% with associated severe mental illness (schizophrenia, other psychotic disorders, bipolar disorder and periodic depression). It is expected that 10% will suffer from underlying organic disorders of dementia or mental retardation. 2. Fifty percent of the sample will establish contact with mental health services within 3 months after attempt of referral, and 30% of the sample will remain in contact for more than 6 months