The purpose of this study is to determine the effectiveness of escitalopram, an anti-anxiety drug, for generalized anxiety disorder (GAD) in elderly individuals. This study will also examine the ways genetics affect response to treatment for GAD.

GAD is a serious public health issue; particularly among the elderly, prevalence of the condition is high, and functional burden on those with the illness is significant. GAD is associated with irregular levels of neurotransmitters, chemicals that carry messages across nerve endings. Serotonin is a neurotransmitter that helps regulate mood and emotions; increased levels of serotonin have been shown to reduce anxiety. Standard treatment for GAD typically involves selective serotonin reuptake inhibitors (SSRIs), drugs that reduce serotonin re-entry into nerve cells. Escitalopram is an SSRI that is well tolerated and highly specific for the serotonin transporter (SERT). This study will determine the effectiveness of escitalopram in reducing anxiety symptoms among elderly GAD patients. In addition, this study will determine whether genetic variations in the SERTs of GAD patients influence these participants' response to treatment.

This study will last 24 weeks. Participants will be randomly assigned to receive either escitalopram or placebo for the first 12 weeks. For the second 12 weeks, all participants will receive escitalopram. Participants will have weekly study visits; during these visits, participants will complete self-report questionnaires on functional ability and anxiety symptoms. Blood collection and cognitive testing through various tasks will also occur at each study visit.

Ages Eligible for Study:  60 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

• Diagnosis of at least moderately severe generalized anxiety disorder (GAD)

Exclusion Criteria:

• Serious suicide risk or psychiatric instability that would affect study participation
• Dementia
• Substance abuse, such as alcoholism, within 6 months prior to study entry
• Diagnosis of schizophrenia, schizoaffective disorder, delusional disorder, or bipolar disorder
• Unstable medical conditions that would preclude the use of escitalopram
• Use of certain psychotropics that can not be safely tapered or discontinued for at least 2 weeks prior to and during the study
• Use of neuroleptics that are absorbed over a prolonged period of time within 6 weeks prior to study entry