Case Study
Case presentation
A 39-year-old bank manager was referred to a psychiatrist following frequent complaints of acute anxiety, irritability, and sleeplessness.
Medical history
- Restlessness and irritability triggered by work-related pressure or deadlines
- Difficulty concentrating on work
- Worsening symptoms along with a sedentary lifestyle
- Difficulty in daily functioning and disturbed sleep
Physical examination
 |
Blood pressure | 120/79 mm Hg |
 |
Oxygen saturation | 99% |
 |
Pulse rate | 80 bpm |
 |
Body mass index | 25.5 kg/m2 |
Investigations
 |
Thyroid function tests | Normal |
 |
Fasting, post-prandial blood sugar | Normal |
Mental status examination
- DASS-21 (Depression Anxiety Stress Scales-21) = 10
- GAD-7 Assessment (Generalised anxiety disorder-7) = 14
Diagnosis: Generalised anxiety disorder (GAD)
Management: Fixed-dose combination (FDC) of Clonazepam (0.5 mg) and Escitalopram Oxalate (10 mg) once daily
Follow-up
- After 4 weeks, noticeable improvement was observed in both the frequency and severity of anxiety-related symptoms such as disturbed sleep and mood swings
- This improvement was reflected in the reduction of symptom scores, with DASS-21 = 5 and GAD-7 = 2
- After discontinuing treatment, the patient was advised monthly follow-ups for monitoring withdrawal symptoms
- After 2 months of stopping therapy, no withdrawal symptoms were experienced
Discussion
- Generalised anxiety disorder is characterised by persistent, excessive, and unrealistic worry about everyday things1
- The main advantages of an FDC are increased patient compliance, decreased pill burden, reduced complications, and cost of treatment2
- In a study by Yadav et al., the combination of Clonazepam and Escitalopram (22.44%) was the most frequently prescribed FDC in psychiatric patients2
- When assessing the rationality of FDCs, Clonazepam and Escitalopram patient group achieved a score of 8 in the seven-point criteria that utilises safety and efficacy as primary factors2
Conclusion
The combination therapy of Clonazepam and Escitalopram is a safe and efficacious option for treating patients with GAD.
References:
- Munir S, Takov V. Generalized Anxiety Disorder. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
- Yadav AK, Jeenger J, Panwar D. Evaluation of rationality of fixed-dose combinations prescribed in psychiatric patients. Natl J Physiol Pharm Pharmacol 2016; 6:150-4.
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