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.
Lenze
Results were reported in the Jan. 21 issue of the Journal of the American Medical Association.
Patients in the study had generalized anxiety disorder, 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,” said principal investigator Eric J. Lenze, M.D., associate professor of psychiatry.
“They worry about very real things, but the inability to put those worries out of their minds makes the condition disabling,” he said.
Older adults with anxiety disorders are typically either not treated or are prescribed sedative drugs 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 age 60, with an average age of 73.
Half received the SSRI drug escitalopram, and the rest took a 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 milligrams to 20 milligrams. 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 said. “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 said. “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.”
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 said. “We’re conducting a study that combines drug treatment with a type of psychotherapy called cognitive behavior therapy.”
That study includes investigators at the School of Medicine, the University of Pittsburgh and the University of California, San Diego. It will treat patients for 56 weeks. Lenze said 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.
For more information about the new study, contact Grace Snell at 747-1387 or gsnell@wustl.edu.