***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Little is known about the effect of pharmacotherapy in the prevention of  post-traumatic stress disorder ( PTSD ) relapse .  AIMS To assess the efficacy and tolerability of fluoxetine in preventing PTSD relapse . METHOD This was a double-blind , r and omised , placebo-controlled study . Following 12 weeks of acute treatment , patients who responded were rer and omised and continued in a 24-week relapse prevention phase with fluoxetine ( n=69 ) or placebo ( n=62 ) . The primary efficacy assessment was the prevention of PTSD relapse , based on the time to relapse . RESULTS Patients in the fluoxetine/fluoxetine group were less likely to relapse than patients in the fluoxetine/placebo group ( P=0.027 ) . There were no clinical ly significant differences in treatment-emergent adverse events between treatment groups . CONCLUSIONS Fluoxetine is effective and well tolerated in the prevention of PTSD relapse for up to 6 months This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer BACKGROUND The results from our 1 year placebo-controlled maintenance/discontinuation study in remitted panic disorder with agoraphobia patients confirmed the significant prophylactic effectiveness of imipramine maintenance treatment but suggested that this may be necessary in only 37 % of the patients who relapse following discontinuation of 6 months acute imipramine treatment . This paper presents pilot data from a second year extension of the above-mentioned study with the aim of exploring the putative protective effects of maintenance imipramine therapy beyond the 1st year . METHOD Eighteen patients from the 30 who survived , in stable remission , the first 12 months of the maintenance/discontinuation study gave written consent to participate in a double-blind 2nd year extension phase with the knowledge that those on placebo will continue on the same condition ( N = 7 , PBO-PBO ) and those on imipramine ( N = 11 ) will be rer and omized to 2nd year maintenance ( N = 4 , IMI-IMI ) or placebo substitution ( N = 7 , IMI-PBO ) . The procedures continued unchanged from that of the 1st year of the study and patients were followed with planned assessment s every 2 months over the second 12-month experimental period of the study . RESULTS None of the IMI-IMI patients relapsed , two ( 28.5 % ) of the IMI-PBO patients relapsed , and two ( 28.5 % ) of PBO-PBO patients relapsed . The mean estimated time without relapse was 10 months and 9 months for IMI-PBO and PBO-PBO , respectively . The estimated probability of not relapsing was .64 for IMI-PBO and .60 for PBO-PBO ( Mantel-cox test chi2 = .84 , p = .77 ) . CONCLUSION These interlocking controlled observations tentatively suggest that a substantial degree of prophylactic efficacy continues and that a substantial need for continued prophylaxis exists beyond the 1st year of maintenance imipramine treatment in panic disorder with agoraphobia patients Background : Social anxiety disorder ( SAD ) is associated with substantial reduction in health-related quality of life ( HRQoL ) .  Escitalopram has proven efficacy in the short-term treatment of SAD and prevention of relapse . Objectives : To determine whether the clinical effects of treatment translated into HRQoL benefits and to investigate costs of SAD treatment . Methods : Data on HRQoL and re source utilisation were collected in a previously published clinical trial of escitalopram in relapse prevention . Among 517 patients , 371 responded to 12 weeks of open-label treatment with escitalopram  and were r and omised to escitalopram or placebo for 24 weeks .  HRQoL was assessed using the short form (SF)-36 instrument and SF-6D utilities ( preference-based index scores for overall HRQoL ) were calculated . Costs were calculated for responders over the acute phase and for non-relapsed patients over the continuation phase , applying UK unit costs . Results : Health-related quality of life was significantly improved after the acute phase when compared with baseline . The SF-6D utility increased by 0.047 in responders ( p < 0.0001 ) and 0.021 in non-responders ( p = 0.0005 ) . Healthcare costs were non-significantly lower in acute phase than during pre study phase ( p = 0.0587 from NHS perspective ) , as were productivity costs ( p = 0.1440 ) . HRQoL at last visit was lower in relapsed than non-relapsed patients . The difference in utility was −0.026 ( p = 0.0007 ) . Healthcare and productivity costs were non-significantly lower in the escitalopram group than in the placebo group . Conclusions : Both effective acute treatment of SAD and prevention of relapse with escitalopram are associated with significant HRQoL benefits . Despite some limitations , the cost analysis suggests that savings in physician-visits and inpatient care may offset drug acquisition costs ABSTRACT Background : Improving health-related quality of life ( HRQoL ) should be a treatment goal for patients with Generalised Anxiety Disorder ( GAD ) . Objectives : To assess the impact of treatment with escitalopram on HRQoL as well as the effect of relapse on HRQoL and work productivity . Methods : This study was conducted alongside a double-blind , placebo-controlled , relapse prevention multinational clinical trial . Relapse was defined as a Hamilton Anxiety Scale ( HAMA ) ≥ 15 . Treatment responders ( HAMA ≤ 10 ) after 12 weeks of open-label treatment ( 10 mg/day escitalopram for Week 1 followed by 20 mg/day thereafter ) were included . The study data set comprised patients ( n = 329 ) from French , Canadian , German and Swedish centres . HRQoL was assessed using the SF-36 scale , and data on sick leave and on-the-job productivity as measured by the Work Limitation Question naire and the work efficacy and work satisfaction visual analogue scales ( VAS ) scales were collected at baseline , r and omization ( Week 12 ) , Weeks 36 , 60 and at last assessment . For future health economic analysis , quality adjusted life years were calculated from the SF-36 results . Results : At baseline , GAD patients reported significantly impaired quality of life compared with the general population . During the 12-week open-label treatment period , treatment responders reported significant improvements in HRQoL on all dimensions of the SF-36 ( p < 0.001 ) and on-the-job productivity ( p < 0.001 ) , whereas sick leave decreased but did not reach statistical significance . After r and omization , relapsed patients reported significantly lower QoL than non-relapsed patients on all 4 SF-36 mental health dimensions ( p < 0.001 ) . Relapsed patients reported slightly lower on-the-job productivity than non-relapsed patients and scored lower on the work efficacy and work satisfaction VAS scales . Conclusion : GAD adversely affects patient functioning and daily life . Short-term treatment with escitalopram reverses this impairment to population norms . GAD relapse is associated with a deterioration of HRQoL and work productivity Abstract : The effect of fluoxetine ( FLU ) in posttraumatic stress disorder was studied in a one-year trial . Subjects received open-label treatment for 6 months , followed by double-blind r and omized treatment with FLU or placebo ( PBO ) for 6 months . Rates of relapse were compared using the Clinical Global Impressions of Improvement .  One hundred twenty-three subjects entered open-label treatment , of whom 114 returned at least once . Sixty-two subjects were r and omized to receive FLU or PBO , of whom 57 returned at least once and were analyzed . The dose of FLU ranged from 10 to 60 mg/d ; at r and omization , mean doses were 48.6 and 42.1 mg for FLU and PBO groups . Rates of relapse were 22 % for FLU versus 50 % for PBO ( P = 0.02 ) , and time to relapse on FLU was longer than for PBO ( P = 0.02 , log-rank statistic ) . The odds ratio for relapse on PBO relative to FLU was 3.50 . No significant differences were found on other measures . Fluoxetine was well tolerated during double-blind treatment OBJECTIVE The study examined the efficacy of sertraline , compared with placebo , in sustaining improvement and preventing relapse over 28 weeks in patients with posttraumatic stress disorder ( PTSD ) who had completed a 12-week double-blind , placebo-controlled acute treatment study and a subsequent 24-week open-label study of continuation treatment with sertraline . METHOD Ninety-six patients were r and omly assigned , in a double-blind design , to 28 weeks of maintenance treatment with sertraline ( 50 - 200 mg , N=46 ; 78 % were women ) or placebo ( N=50 ; 62 % were women ) . Measures used in biweekly assessment s included the Clinician-Administered PTSD Scale , the Impact of Event Scale , and the Clinical Global Impression severity and improvement ratings . Kaplan-Meier analyses were used to estimate time to discontinuation from the study due to relapse , relapse or study discontinuation due to clinical deterioration , and acute exacerbation . RESULTS Continued treatment with sertraline yielded lower PTSD relapse rates than placebo ( 5 % versus 26 % ) . Patients who received placebo were 6.4 times as likely to experience relapse as were patients who received sertraline . Kaplan-Meier analyses confirmed the protective effect of sertraline in significantly extending time in remission . The ability of sertraline to sustain improvement was comparable across the three core PTSD symptom clusters ( reexperiencing/intrusion , avoidance/numbing , and hyperarousal ) . A regression analysis found early response during acute treatment to be associated with a more than 16-fold reduced risk of relapse after placebo substitution . Sertraline , at a mean endpoint dose of 137 mg , was well tolerated , with no sertraline-related  adverse events observed at a rate of 10 % or higher . CONCLUSIONS The results provide evidence for the ability of sertraline both to sustain improvement in PTSD symptoms and to provide prophylactic protection against relapse To examine the efficacy and tolerability of escitalopram in the prevention of relapse in patients with OCD , 468 patients with OCD were treated with open label escitalopram ( 10 mg or 20 mg ) for 16 weeks , after which the 320 responders ( Y-BOCS total score decrease > or = 25 % ) were r and omised to placebo or escitalopram ( at the assigned dose ) for 24 weeks double-blind treatment . The primary analysis ( time to relapse ) showed a significant advantage for escitalopram ( p<0.001 , log-rank test ) . The proportion of patients who relapsed was statistically significantly higher in the placebo group ( 52 % ) than in the escitalopram group ( 23 % ) ( p<0.001 , chi(2)-test ) . The risk of relapse was 2.74 times higher for placebo compared to escitalopram . Escitalopram was well tolerated and improvements in obsessive-compulsive symptoms reported during the open label period were sustained during the double-blind extension of treatment with active drug . These results demonstrate that escitalopram is effective for long-term treatment and relapse prevention in OCD Objective : To investigate the long‐term efficacy , prevention of relapse and safety of sertraline in the treatment of panic disorder Several issues remain to be ascertained beyond the acute response to imipramine hydrochloride in patients with panic disorder . Study 1 consisted of a prospect i ve , systematic characterization of half-dose 12-month maintenance in patients with panic disorder with agoraphobia who had shown marked and stable response to 6 months of acute-phase treatment with imipramine .  Study 2 assessed the 6-month cumulative relapse rate following discontinuation of acute-phase imipramine treatment in a comparable sample of patients . The same assessment battery was used in both studies , and the integrity of experimental drug conditions was verified by plasma drug level determinations . In contrast to the high relapse rate following discontinuation of acute-phase treatment , none of the patients showed relapse or had sustained worsening in panic or phobia measures during the half-dose maintenance period . The results underscore the importance of pharmacological prophylaxis and provide empirical guidelines for a successful low-dose maintenance regimen for patients with panic disorder and agoraphobia who respond markedly to imipramine Escitalopram 
    Output:
    
Conclusions Up to one year of follow‐up , discontinuation of antidepressant treatment results in higher relapse rates among responders compared with treatment continuation .
The lack of evidence after a one year period should not be interpreted as explicit advice to discontinue antidepressants after one year .