Anxiety Therapy Options for Seniors

Generalized anxiety disorder in seniors eased in trial with medication and or counseling

(RxWiki News) Long-term anxiety can eat away at a person’s physical and mental health. Seniors with anxiety may find relief through a couple of different treatment options.

A recent clinical trial tested four different therapy combinations for treating anxiety in seniors.

The results of this trial showed that both antidepressant medication and counseling sessions helped ease worry and anxiety among seniors.

"Seek help for anxiety."

Julie Loebach Wetherell, PhD, from the Veterans Administration San Diego Healthcare System and the University of California San Diego, led this study about the use of antidepressant medication and counseling to help manage general anxiety in seniors.

"Generalized anxiety disorder is characterized by difficult-to-control worry, accompanied by [physical] and psychological symptoms such as restlessness, sleep disturbance and muscle tension," wrote Dr. Wetherell and colleagues.

According to these researchers, generalized anxiety disorder (GAD) is common among seniors and can lead to a decline in overall health and mental function.

Previous research has estimated that roughly 7 percent of seniors have GAD.

For this small clinical trial, 73 people with GAD, at least 60 years of age, were recruited from three different outpatient clinics between 2008 and 2010.

At the start of the study, all of the participants were given 10 mg per day of the antidepressant escitalopram (brand name Lexapro) for 12 weeks. If symptoms did not improve after four weeks, the dosage was increased to 20 mg per day. 

After 12 weeks, participants who had at least 20 percent improvement in scores on an anxiety test were randomly split into four groups with different combinations of medication and counseling.

In the counseling sessions, cognitive behavioral therapy was used. According to the Mayo Clinic, cognitive behavioral therapy is a common type of mental health counseling that helps patients become aware of inaccurate or negative thinking and respond in a more effective way.

The first group received 16 more weeks of escitalopram and 16 weekly counseling sessions, followed by 28 weeks of escitalopram without counseling.

The second group received 44 weeks of escitalopram alone. The third group received escitalopram and counseling for 16 weeks, followed by a placebo, or fake pill, for 28 weeks.

The fourth group received escitalopram for 16 weeks with no counseling, followed by a placebo for 28 weeks.

Those who switched from the antidepressant to a placebo were properly tapered off of the medication.

After the 44-week maintenance period, the results showed that people who had some combination of counseling and medication, either together or alone, reported less worry and anxiety compared to people in the placebo-only group. 

A total of 66 percent of people receiving a placebo, but no therapy, reported worry and anxiety, compared to only 25 percent of those receiving a placebo with therapy.

Only 5 percent of those receiving escitalopram but no therapy experienced a relapse back into significant anxiety. 

The study authors concluded that the use of an antidepressant plus counseling helped to reduce anxiety and continued use of medication helped to prevent a relapse of anxiety. 

The authors wrote that after short-term use of antidepressants, cognitive behavioral therapy alone may prevent relapse into anxiety for some patients without continued use of medication.

"There is a critical step in GAD in which the initial anxiety impulse produces a proliferation of reactive thinking (worrying). Older people have a harder time controlling this reactive conversion," Peter Strong, PhD, professional psychotherapist and author of The Path of Mindfulness Meditation, told dailyRx News.

"The use of an SSRI [a class of antidepressants that includes escitalopram] can be particularly helpful in reducing the intensity of this initial anxiety impulse; the value of cognitive behavioral therapy is in modifying the proliferation of reactive thinking. For this reason, the combination of SSRI and cognitive behavioral therapy can be particularly effective in the control of GAD and for the prevention of relapse," said Dr. Strong, who was not involved with this study.

This study was published in July in The American Journal of Psychiatry.

The National Institute of Mental Health and the National Institute on Aging provided grant support for this project.

Drs. Wetherell and Lenze declared financial relationships with the makers of escitalopram, Forest Laboratories. Other financial conflicts of interest were reported by Dr. Lenze, including Johnson and Johnson, Lundbeck, Roche and Fox Learning Systems.

Review Date: 
July 7, 2013