anxiety

An epilepsy drug seems to act faster than a standard option.

* THE QUESTION When people have chronic worry and tension -- often for no apparent reason and usually accompanied by fatigue, headache, nausea or trembling -- doctors can pick from various drugs to tailor treatment. Might pregabalin -- which has been used to treat epilepsy and fibromyalgia -- be an addition to the arsenal against this illness, called generalized anxiety disorder?

* THIS STUDY randomly assigned 454 adults with generalized anxiety disorder to take pregabalin, alprazolam or a placebo daily. Alprazolam (Xanax) is commonly prescribed for anxiety. After four weeks, people taking either of the two drugs showed more improvement on standardized anxiety rating scales than those in the placebo group, with scores falling (indicating fewer symptoms) 11 or 12 points from about 25 at the start of the study, compared with a decline of roughly eight points for the placebo group. People taking pregabalin noted improvements more quickly than those taking alprazolam, including a decrease in physical symptoms that was not immediately seen by those taking the other drug.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Adults with generalized anxiety disorder, which affects an estimated 4 million Americans.

* CAVEATS The study was too short to determine whether pregabalin would be safe and effective long-term. Pfizer, which makes the drug, funded the study; five of the 10 authors had financial ties to the company.

* FIND THIS STUDY September issue of the Archives of General Psychiatry; abstract available online at www.archgenpsychiatry.com.

* LEARN MORE ABOUT generalized anxiety disorder at www.adaa.org and www.nimh.nih.gov/healthinformation.

Chronic obstructive pulmonary disease

Serious flare-ups may decrease with use of an inhaled drug.

* THE QUESTION When breathing is difficult because the air passages have become clogged after years of smoking, serious episodes of coughing, wheezing and shortness of breath often send people to the emergency room. Might tiotropium (Spiriva) -- an inhaled drug sometimes used to maintain lung function in people with this problem, called chronic obstructive pulmonary disease (COPD) -- also reduce the number of flare-ups?

* THIS STUDY randomly assigned 1,829 people, nearly all white men, with moderate to severe COPD to inhale tiotropium or a placebo daily. Over six months, fewer people taking tiotropium than taking the placebo had an episode of chest tightness, coughing or wheezing lasting at least three days and requiring medication or hospitalization (28 percent vs. 32 percent). For about 7 percent of the drug group, the episodes led to hospitalization, compared with about 10 percent of the others.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with COPD, a disease that combines chronic bronchitis and emphysema and is characterized by generally nonreversible airway obstruction. More than 16 million Americans have been diagnosed with COPD.

* CAVEATS The study did not determine whether the drug would control flare-ups over the long term, and results may not apply to people other than white men. Beohringer Ingelheim Pharmaceuticals designed the study and collected and analyzed the data. Funding came from Beohringer and Pfizer, which jointly market the drug; three of the eight authors worked for Beohringer, and the others had received fees from the company.

* FIND THIS STUDY Sept. 6 issue of the Annals of Internal Medicine; abstract available online at www.annals.org.

* LEARN MORE ABOUT COPD at www.nhlbi.nih.gov/health and www.mayoclinic.com.

fractures

Soy-based foods appear to help older women keep bones intact.

* THE QUESTION Worries about health risks associated with hormone therapy have prompted many women to reject it as an option after menopause. Might eating soy-based foods offer an alternative for preventing the broken bones that often follow post-menopausal bone loss?

* THIS STUDY analyzed the diets of 24,403 post-menopausal women, comparing the amount of soy they consumed with the number of broken bones they sustained. In about 4 1/2 years, 1,770 broken bones were reported. Women who ate the most soy foods (13 grams or more of soy protein daily) were 37 percent less likely to break a bone than were those who consumed the least (less than five grams of soy protein a day). Women registered the greatest benefit during the first 10 years after menopause, when consumers of the most soy were 48 percent less likely to break a bone than were those who took in the least.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Post-menopausal women, for whom accelerated loss of bone density can lead to osteoporosis and fractures.

* CAVEATS The authors suggested that the findings indicate that soy consumption may be more beneficial in preventing bone loss than in reversing it. Data on fractures were based on the participants' reports and were not confirmed through medical records; some fractures may have resulted from high-impact trauma rather than osteoporosis. All participants were Chinese; whether the results apply to other women remains unclear.

* FIND THIS STUDY Sept. 12 issue of the Archives of Internal Medicine; abstract available online at www.archinternmed.com.

* LEARN MORE ABOUT osteoporosis and bone fractures at www.cdc.gov (search for "bone health") and at www.osteo.org.

-- Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.