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Anxiety Symptoms in Elderly Patients with Depression

What is the Best Approach to Treatment?

  • Therapy in Practice
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Abstract

Depressed elderly persons frequently have concurrent symptoms of anxiety or comorbid anxiety disorders. Such comorbidity is associated with a more severe presentation of depressive illness, including greater suicidality. Additionally, most antidepressant treatment studies in the elderly have found poorer treatment outcomes in those with comorbid anxiety (including delayed or diminished response and increased likelihood of dropout from treatment).

While antidepressants such as selective serotonin reuptake inhibitors and tricyclic agents are efficacious for late-life depression, there is no evidence that either class is superior, in terms of efficacy or tolerability, in the treatment of anxious depression. Rather, the amount and quality of clinical management, and not the particular medication chosen, appears to influence the likelihood of remission or treatment withdrawal in anxious depressed elderly patients. Co-prescription of benzodiazepines, typically lorazepam, is also warranted in some cases for severe anxiety or insomnia, but carries the risk of cognitive or motor impairment.

It is our experience that close clinical monitoring, together with maximisation of antidepressant treatment (by maximising dosage, augmenting or switching agents in cases of partial or no response, and/or adding psychotherapy) will almost always result in remission of depressive symptoms, together with improvement of anxiety, in these individuals. Therefore, optimism should be maintained when treating the depressed elderly individual, even when comorbid anxiety is present.

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Acknowledgements

Supported by NIMH grants K23 MH64196, P30 MH 52247, K05 MH00295, K01 MH01613, R37 MH43832, R01 MH37869, and T32 MH19986. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Psychiatry, Intervention Research Center in Late-Life Mood Disorders, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Eric J. Lenze, Benoit H. Mulsant, M. Katherine Shear, Patricia Houck & Charles F. Reynolds III

  2. Geriatric Research, Education and Clinical Center (GRECC), VA Pittsburgh Health System, Pittsburgh, Pennsylvania, USA

    Benoit H. Mulsant

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  1. Eric J. Lenze
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  2. Benoit H. Mulsant
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  3. M. Katherine Shear
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  4. Patricia Houck
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  5. Charles F. Reynolds III
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Correspondence to Eric J. Lenze.

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Lenze, E.J., Mulsant, B.H., Shear, M.K. et al. Anxiety Symptoms in Elderly Patients with Depression. Drugs Aging 19, 753–760 (2002). https://doi.org/10.2165/00002512-200219100-00004

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