Therapeutics in Late-Life Anxiety Disorders—An Update

Abstract

The first choice treatments for all anxiety disorders (ADs) are cognitive behavioral therapy (CBT), pharmacological treatment with antidepressants, or their combination. However, empirical findings for these treatments in elderly suffering from ADs are still scarce. The scarcity of empirical research in this age group may be attributable to the fact that late-life anxiety is generally viewed as a minor health problem, and therefore, that we are dealing with a population that tends to go largely underdiagnosed and hence un(der)treated. From a mental-health perspective, both the material and immaterial costs of this unmet need are substantial. If left untreated, late-life anxiety has a tendency to become chronic and is associated with a substantial risk of major depression, increases in health-care utilization, reduced quality of life, more disability, and increased relative mortality risk. Additionally, most elderly suffering from ADs remain in primary care. This is partly complicated by their worries about stigmatization and reluctance to be referred to specialized mental health care. Therefore, the main issue to solve is how to increase both the detection rate and proper treatment of late-life anxiety in primary care. The following signals in elderly patients may indicate an anxiety disorder: frequent visits to the primary care physician with fluctuating, unexplained somatic symptoms, chronic and non-specific stress-related symptoms (nervousness, irritability, sleep disorder, concentration problems, emotional instability, apathy), hyperventilation, palpitation, dizziness, frequent request for tranquillizers, alcohol abuse, depression, avoidance of (social) activities. Although far from conclusive, the available evidence suggests efficacy, although limited, for CBT in late-life ADs compared with CBT for ADs in younger adults. In the treatment of late-life generalized anxiety disorder there is no difference between CBT or alternative psychological treatments like supportive counseling or a discussion group. The efficacy of antidepressant treatment with selective serotonin re-uptake inhibitors (SSRIs) or tri-cyclic antidepressants (TCAs) seems to be comparable in both younger and older adults. However, one has to keep in mind that direct comparisons of CBT or pharmacological treatment between younger and older adults suffering from ADs have not yet been conducted. Therefore, the main treatment options in late-life ADs are comparable with those in younger adults with ADs.