Antidepressants May Be Beneficial To Older Adults Who are Suffering From Anxiety

By Jim Dryden

Jan. 20, 2009 -- Many 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."

For more information about the new study, which combines drug therapy with cognitive behavior therapy to treat generalized anxiety disorder, contact Grace Snell at 314-747-1387 or gsnell@wustl.edu.

Lenze, EJ, Rollman BL, Shear MK,Dew MA, Pollock BG, Ciliberti C, Costantino M, Snyder S, Shi P, Spitznagel E, Andreescu C, Butters MA, Reynolds CF III. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. Journal of the American Medical Association, vol 301(3), pp. 295-303. Jan. 21, 2009

This study was supported by the National Institute of Mental Health, the John A. Hartford Center of Excellence in Geriatric Psychiatry and the University of Pittsburgh Medical Center endowment in geriatric psychiatry. Forest Laboratories, which holds the U.S. patent for escitalopram, provided the drug and matching placebo for the study.

Dr. Lenze receives research support from Forest Laboratories.

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's Hospitals. The School of Medicine is one of the leading medical research, teaching, and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's Hospitals, the School of Medicine is linked to BJC HealthCare.