Mental health professionals have long debated the usefulness of prescribing antidepressants in older anxious adults. A article published in Medical News Today January 21, 2009, “Anxious Older Adults May Benefit From Antidepressants,” examines this issue.The article reports on a study published in the Jan. 21, 2009 issue of the Journal of the American Medical Association. The researchers 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.” The results were interesting. “After 12 weeks of treatment, 68 percent of patients taking escitalopram had improved. About 51 percent of those taking the placebo showed improvement.” All the patients met the criteria for the diagnosis of 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..They worry about very real things, but the inability to put those worries out of their minds makes the condition disabling." The researchers note that many of these older patients are prescribed by their Primary Care Physician a strong sedative like Xanax, Valium, Klonopin, or Ativan for their symptoms. Unfortunately, many of these medications have significant side effects in the elderly including confusion and imbalance making them at risk for falls and other mishaps. Clinical experience shows that long term use of these agents can cause significant cognitive impairment in the long run. The researchers also noted another interesting finding from the study. “…that escitalopram helped some patients lower blood pressure…if their blood pressure was normal, it stayed the same. If they had high blood pressure, it got better." An initial side effect of antidepressants in this population was fatigue and sleepiness but that resolved within a few weeks on the medication. One question that was not addressed by this study was the positive impact of targeted cognitive behavioral therapy for these symptoms either alone or in combination with medication. The answer to that question will have to await further study.
The Bottom Line: The results of these studies suggests that antidepressants may be helpful in the treatment of anxiety in the elderly.
Reference: Original Article
Resources:
Great Youtube Video on Depression in Older Adults:
Great Informational Websites Created by Dr. Speller and Dr. Korkosz:
Sources: See blogposts in Psychiatric Disorders: General and Psychiatric Disorders: Aging
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