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Anxious older adults may benefit from antidepressants
January 21, 2009Many older adults worry - a lot. Almost one in 10 Americans over age 60 suffer from an anxiety disorder that causes them to worry excessively about normal things - like health, finances, disability and family. Although antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) can improve anxiety symptoms in younger adults, little has been known about their effects in older people.
In the largest study of SSRIs in older people with anxiety disorders, a team of psychiatric researchers found the drug escitalopram (Lexapro®) improved anxiety symptoms and quality of life. Results are reported in the Jan. 21 issue of the Journal of the American Medical Association.
Patients in the study had Generalized Anxiety Disorder (GAD), a condition of chronic, difficult-to-control worry. Associated symptoms include insomnia, fatigue, muscle tension and irritability.
"A person with Generalized Anxiety Disorder spends, on average, about 40 hours a week worrying, so it's almost like having a full-time job," says principal investigator Eric J. Lenze, M.D., associate professor of psychiatry at Washington University School of Medicine in St. Louis. "They worry about very real things, but the inability to put those worries out of their minds makes the condition disabling."
Older adults with anxiety disorders are typically either not treated or prescribed sedative drugs known by trade names such as Valium® and Xanax®. Sedatives can relieve anxiety, but their long-term use in older adults is linked to falls and cognitive impairment. SSRI drugs are thought to be a safer alternative, but it wasn't clear if they could reduce anxiety in this age group.
Lenze led the study while at the University of Pittsburgh. His team studied 177 people over the age of 60. Average age was about 73.
Half received the SSRI drug escitalopram, and the rest took an inactive placebo. Participants took one pill per day. If their symptoms didn't improve after four weeks, a second pill was added. In patients receiving the drug, taking two pills increased the dosage from 10 mg. to 20 mg. The higher dose more effectively reduced anxiety.
After 12 weeks of treatment, 68 percent of patients taking escitalopram had improved. About 51 percent of those taking the placebo showed improvement.
"We found improvements not only in anxiety and level of worry but also in functioning," Lenze says. "Many people who took the drug felt they were better able to carry out daily role activities related to their work or family life."
Interestingly, the researchers also noted that escitalopram helped some patients lower blood pressure.
"We noticed if their blood pressure was normal, it stayed the same. If they had high blood pressure, it got better," he says. "It's a preliminary finding, and more research is needed, but it suggests that anxiety treatment in this age group can help with other health problems."
The main side effect of escitalopram in this study was fatigue and sleepiness. That surprised the research team because the drug is not a sedative; however, the symptoms usually went away after a few weeks, and the drug was well tolerated overall.
Although escitalopram helped, Lenze calls the benefits modest.
"That doesn't mean an older adult shouldn't take an SSRI for an anxiety disorder, but it appears the medication alone usually won't be sufficient," he says. "We're currently conducting a study that combines drug treatment with a type of psychotherapy called cognitive behavior therapy."
That study includes investigators at the University of Pittsburgh, the University of California at San Diego and Washington University. This study treats patients for 56 weeks. Lenze believes the long-term nature of the study will provide better answers about how to effectively treat anxiety in older adults and whether doing so improves health.
"Most older adults with an anxiety disorder never see a mental health specialist," Lenze says. "They are more likely to see a gastroenterologist for GI difficulties or a rheumatologist for muscle pain than to go to a psychiatrist. They may feel stress and worry about things, but some other symptom is what gets them to go to the doctor."
Washington University in St. Louis
"A person with Generalized Anxiety Disorder spends, on average, about 40 hours a week worrying, so it's almost like having a full-time job," says principal investigator Eric J. Lenze, M.D., associate professor of psychiatry at Washington University School of Medicine in St. Louis. "They worry about very real things, but the inability to put those worries out of their minds makes the condition disabling."
Older adults with anxiety disorders are typically either not treated or prescribed sedative drugs known by trade names such as Valium® and Xanax®. Sedatives can relieve anxiety, but their long-term use in older adults is linked to falls and cognitive impairment. SSRI drugs are thought to be a safer alternative, but it wasn't clear if they could reduce anxiety in this age group.
Lenze led the study while at the University of Pittsburgh. His team studied 177 people over the age of 60. Average age was about 73.
Half received the SSRI drug escitalopram, and the rest took an inactive placebo. Participants took one pill per day. If their symptoms didn't improve after four weeks, a second pill was added. In patients receiving the drug, taking two pills increased the dosage from 10 mg. to 20 mg. The higher dose more effectively reduced anxiety.
After 12 weeks of treatment, 68 percent of patients taking escitalopram had improved. About 51 percent of those taking the placebo showed improvement.
"We found improvements not only in anxiety and level of worry but also in functioning," Lenze says. "Many people who took the drug felt they were better able to carry out daily role activities related to their work or family life."
Interestingly, the researchers also noted that escitalopram helped some patients lower blood pressure.
"We noticed if their blood pressure was normal, it stayed the same. If they had high blood pressure, it got better," he says. "It's a preliminary finding, and more research is needed, but it suggests that anxiety treatment in this age group can help with other health problems."
The main side effect of escitalopram in this study was fatigue and sleepiness. That surprised the research team because the drug is not a sedative; however, the symptoms usually went away after a few weeks, and the drug was well tolerated overall.
Although escitalopram helped, Lenze calls the benefits modest.
"That doesn't mean an older adult shouldn't take an SSRI for an anxiety disorder, but it appears the medication alone usually won't be sufficient," he says. "We're currently conducting a study that combines drug treatment with a type of psychotherapy called cognitive behavior therapy."
That study includes investigators at the University of Pittsburgh, the University of California at San Diego and Washington University. This study treats patients for 56 weeks. Lenze believes the long-term nature of the study will provide better answers about how to effectively treat anxiety in older adults and whether doing so improves health.
"Most older adults with an anxiety disorder never see a mental health specialist," Lenze says. "They are more likely to see a gastroenterologist for GI difficulties or a rheumatologist for muscle pain than to go to a psychiatrist. They may feel stress and worry about things, but some other symptom is what gets them to go to the doctor."
Washington University in St. Louis
Anxiety Disorder Current Events and Anxiety Disorder News RSSFamily history predicts presence and course of psychiatric disorders
A family history of depression, anxiety, alcohol dependence or drug dependence is associated with the presence of each condition and also may predict its course and prognosis.
To predict the severity of mental disease, consider the family
We've all been asked at routine visits to the doctor to record our family's history with medical problems like cancer, diabetes or heart disease. But when it comes to mental disorders, usually mum's the word.
Postpartum anxiety delays puberty in offspring
Hormonal changes early in pregnancy cause maternal postpartum anxiety and behavior changes that can lead to a delayed onset of puberty in both birth and adoptive daughters, according to a new study conducted in mice.
Hopkins study: When adult patients have anxiety disorder, their children need help too
In what is believed to be the first U.S. study designed to prevent anxiety disorders in the children of anxious parents, researchers at the Johns Hopkins Children's Center have found that a family-based program reduced symptoms and the risk of developing an anxiety disorder among these children.
Medication may provide some benefit for older adults with anxiety disorder
Preliminary research suggests that use of the drug escitalopram provided some improvement in symptoms for older adults with generalized anxiety disorder, although the overall benefits were diminished because of nonadherence to the drug by some patients.
Expectant brains help predict anxiety treatment success
A network of emotion-regulating brain regions implicated in the pathological worry that can grip patients with anxiety disorders may also be useful for predicting the benefits of treatment.
Childhood anxiety disorders can and should be treated, according to UT Southwestern national expert
Anxiety disorders in children and adolescents should be recognized and treated to prevent educational underachievement and adult substance abuse, anxiety disorders and depression, says a nationally recognized child psychiatrist from UT Southwestern Medical Center.
Siblings of mentally disabled face own lifelong challenges, according to researchers
People who have a sibling with a mental illness are more likely to suffer episodes of depression at some point in their lives, say researchers who analyzed four decades of data.
Stress-related disorders affect brain's processing of memory
Researchers using functional MRI (fMRI) have determined that the circuitry in the area of the brain responsible for suppressing memory is dysfunctional in patients suffering from stress-related psychiatric disorders. Results of the study will be presented today at the annual meeting of the Radiological Society of North America (RSNA).
Lower childhood IQ associated with higher risk of adult mental disorders
Researchers have hypothesized that people with lower IQs may have a higher risk of adult mental disorders, but few studies have looked at the relationship between low childhood IQ and psychiatric disorders later in life.
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