Efficacy and Safety of Escitalopram in Alleviating Depression and Anxiety Symptoms in COPD Patients: A Randomized Double-Blind Placebo-Controlled Trial

Purpose: Depression and anxiety negatively impact COPD prognosis, yet evidence for psychopharmacological interventions remains limited. This study evaluated the efficacy and safety of low-dose escitalopram for managing these comorbidities in COPD patients. Patients and methods: In this double-blind, placebo-controlled trial, 150 COPD patients with moderate-to-severe anxiety and/or depression were randomized (1:1) to receive escitalopram (5– 10 mg/day) or placebo for 4 weeks, followed by an 11-month observational follow-up without maintenance study medication. Primary endpoints were changes in HAMA-14 and HAMD-17 scores at Month 1. Secondary outcomes included CAT scores, mMRC ratings, and lung function (FEV 1 % predicted) through Month 12. Results: At Month 1, escitalopram demonstrated significantly greater reductions in HAMA-14 (− 9.25 [95% CI − 9.67 to − 8.82] vs − 2.20 [− 2.46 to − 1.95]) and HAMD-17 (− 7.37 [− 7.74 to − 7.01] vs − 1.37 [− 1.72 to − 1.01]) compared to placebo ( p < 0.01). These improvements were sustained at Month 12 ( p < 0.01). CAT scores improved significantly more in the escitalopram group (− 6.20 [− 6.68 to − 5.72]) versus placebo (− 2.79 [− 3.02 to − 2.55]) over the 12-month observational period ( p < 0.01). No significant differences were observed for mMRC or FEV 1 % predicted. Adverse events were mild and comparable between groups. Conclusion: Short-term treatment with low-dose escitalopram significantly alleviates depression and anxiety in COPD patients. Notably, this brief intervention initiated a sustained positive clinical trajectory over 12 months. Combined with a favorable safety profile, these findings support its potential integration into comprehensive COPD management protocols, pending multicenter validation. Trial Registration: ChiCTR1800017338 ( https://www.chictr.org.cn/ ). Registered 25-July-2018. Keywords: anxiety, CAT score, COPD, depression, escitalopram