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Improving depression and anxiety therapy in seniors

Researchers at Washington University are looking for better ways to help older adults deal with depression and anxiety

June 19, 2013

Depression and anxiety are common symptoms in older adults. About one in every 20 seniors suffers from an anxiety disorder, and a similar number of adults over 65 are clinically depressed. As the population ages, those disorders will continue to affect millions of older people.

Eric Lenze, MD, a Washington University geriatric psychiatrist at Barnes-Jewish Hospital, is studying ways to alleviate those problems. He says although everyone is sad or nervous at times, clinically relevant depression and anxiety aren’t a normal part of growing older.

“Most people we see have had problems for a long time,” says Lenze. “They may have a strong family history of anxiety disorders or depression, and it tends to be a chronic problem. Or they may have new stresses with aging, such as dealing with multiple medical problems. Unfortunately, many seniors suffer from depression or anxiety disorders for years before seeking help.”

More than a passing mood

Lenze says that anxiety, worry and sadness like that associated with grief or having the “blues” is common and usually a normal reaction. This is different from depression or an anxiety disorder. Those who are sad or grief-stricken can continue their normal activities. An older adult with depression has symptoms that interfere with the ability to function normally.

“Depression is very disabling,” Lenze says. “And in older patients, it can even cause problems with memory and attention and can greatly increase the disability that accompanies medical problems such as heart disease. It also increases a person’s risk of death, either from suicide—which is more common in older people than in any other age group—or by making age-related illnesses such as heart disease or cancer more deadly.”

Lenze says late-life depression is a condition that some have had for their entire lives and it simply continues in older age. But for many others, depression is a new disorder that doesn’t really gain a foothold until an older adult begins to face the new stresses and challenges that come with aging, such as grief, social isolation or disability.

Lenze’s team has been testing the effectiveness of various antidepressant drugs, and combinations of drugs, in older adults. They have also been studying a technique called mindfulness-based stress reduction, which is similar to meditation in that it involves monitoring one’s breathing and becoming aware of sensations in the body.

“The idea is that by living more in the present moment, an older person may reduce anxiety, stress levels and depression,” Lenze says.

Calming seniors’ nerves

But living in the present moment isn’t a lot of fun when a person is pathologically nervous and worried about things. In the past, the standard therapy for anxiety has involved anti-anxiety drugs such as benzodiazepines, but these drugs are not ideal for seniors.

“Benzodiazepines are particularly risky in older adults because they can contribute to falls and to cognitive impairment,” says Lenze. “So we have been focusing on alternative strategies for improving anxiety disorders in older adults.”

Lenze’s group has had some success with the antidepressant drug escitalopram and with cognitive behavioral therapy (CBT), but neither by itself has been highly effective. So Lenze recently initiated a multicenter study to evaluate the use of both in combination.

He worked with researchers from the University of California, San Diego; the University of Missouri, St. Louis; and the University of Pittsburgh to study 73 patients at least 60 years old and who suffered from generalized anxiety disorder, a condition of chronic, difficult-to-control worry.

Lenze and his colleagues found that anxiety levels improved with the antidepressant medication, but individuals who also got CBT improved significantly more in a measure of worry pathology called the Penn State Worry Questionnaire.

“Those individuals who received both the drug and cognitive behavioral therapy also had a lower relapse rate, and if they did relapse, it happened much later,” Lenze says. “An anxiety disorder usually has two components: One is a generally high stress level that can be managed with antidepressant medication. But the other component is pathological worry. This aspect of the problem might be helped by cognitive behavioral therapy.”

Lenze and his colleagues also are studying another strategy, called mindfulness-based stress reduction, for reducing excessive worry and depression.

Lenze says those seeking psychotherapy for anxiety disorders and depression may consult any number of psychologists and psychiatrists in the St. Louis area for cognitive behavioral therapy and other effective approaches, including those at the St. Louis Behavioral Institute, Clayton Behavioral and practitioners at Washington University, Saint Louis University and the University of Missouri, St. Louis.

For more information about studies involving seniors with depression or anxiety, interested people may call research patient coordinator Jenny Anger at (314) 362-7354 or e-mail angerj@wustl.edu.