Subject: A multicentre, retrospective, observational survey study to analyse the role of fixed dose
combination (FDC) drug of paroxetine and clonazepam in elderly patients with co-morbid
depression and anxiety
Major depressive disorder (MDD) is a debilitating disease that is characterized by at least one
discrete depressive episode lasting at least 2 weeks and involving clear-cut changes in mood,
interests and pleasure, changes in cognition and vegetative symptoms.1 Depression is a common
mental health disorder that can affect both the mental and physical health. The number of incident
cases of depression worldwide increased from 172 million in 1990 to 258 million in 2017,
representing an increase of 49.86%.2 In 2017, 197·3 million people had mental disorders in India,
including 45·7 million with depressive disorders and 44·9 million with anxiety disorders.3
Anxiety is common among older adults with depressive disorders, both as a symptom and as a
comorbid disorder. The prevalence of comorbid anxiety in late-life depression from related studies
ranges from 0.9% to 47.5%44
Large-scale longitudinal studies converge in their findings suggesting that MDD increases the risk of
diabetes mellitus, heart disease, stroke, hypertension, obesity, cancer, cognitive impairment and
Alzheimer disease.5 Neurocognitive impairment is a relevant factor in the quality of life of patients,
as it is negatively associated with psychosocial functioning in MDD.6
Treatment options for management of depression can be broadly be divided into antidepressants,
electroconvulsive therapy (ECT) and psychosocial interventions. In general, because of the side effect
and safety profile, selective serotonin reuptake inhibitors (SSRIs) are considered to be the first line
antidepressants. Other preferred options include tricyclic antidepressants, mirtazapine, bupropion,
and venlafaxine. Usually the medication must be started in the lower doses and the doses must be
titrated, depending on the response and the side effects experienced.7
Anxiety and depression often co-occur and their comorbidity is commonly seen in MDD patients.
Anxiety disorders are the most common comorbid mental health disorders, with comorbidity
estimates ranging from 15% to 75%.8 Hence, combination treatments have become the norm in
clinical practice for treating anxiety and depression. Most commonly used clinical strategy for
comorbid depression and anxiety is to use combination of SSRIs and benzodiazepines.
Co-administration of benzodiazepines and antidepressants like paroxetine and clonazepam may
have a number of potential benefits including:
-
Treatment of anxiety symptoms during the temporal lag in therapeutic efficacy with initiation of
antidepressant treatment
-
Reduction in the anxiety-like symptoms associated with antidepressant initiation
-
Possible synergistic or additive therapeutic effects9
This FDC is in the form of an extended-release tablet, which may provide a once-daily administration
option for the treatment of co-morbid depression and anxiety.
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