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1 Department of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineNew YorkNYUSA.

How effective is EMSAM in treating comorbid anxiety disorders in MDDOne of the failures in the development of EMSAM was not evaluating this drug in anxiety disorderseither primary or secondary to MDDEven where an anxiety disorder was secondary to MDD as was permitted in three of the four published double-blind clinical trials111214 the effect of EMSAM on the anxiety disorder was not presentedEven the actual comorbid anxiety disorders included and the number of cases in each disorder were not described in the reportsAn important analysis may have been missed since earlier literature on MAOIs suggested that they were very effective in anxiety disorders43 It is also remotely possible that EMSAM may not only be ineffective for anxiety disorders but might exacerbate themFor examplefluoxetinean SSRI antidepressanthas been reported to induce anxietyjitteriness syndromein a subset of patientsparticularly those who have anxiety disorders44 Clearlyknowing what effect EMSAM has on comorbid anxiety disordersa post hoc analysis on the clinical trial data would help answer this important clinical questionis of clinical relevanceThusa post hoc analysis awaits.

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