Anxiety in late-life is a frequently encountered condition. The aim of this review is to systematically examine the efficacy and tolerability of antidepressants for treating anxiety disorders among older adults.
Methods
Electronic searches of The Cochrane Central Register of Controlled Trials and the standard bibliographic databases PubMed, MEDLINE, EMBASE, and PsycINFO were performed in August 2018 and updated in October 2018 for randomized controlled trials (RCTs) evaluating antidepressants for late-life anxiety. The quality of each study was appraised using criteria developed by the Centre for Evidence-Based Medicine.
Results
Data from 12 papers describing 10 RCTs of antidepressants for late-life anxiety are included in this review. There were 2 studies each of sertraline, escitalopram, and duloxetine, and 1 study each of citalopram, paroxetine, venlafaxine, and imipramine. Across all trials, antidepressants were associated with a significant reduction in anxiety symptoms at the end of the study period. Limitations of the trials include a preponderance of generalized anxiety disorder and relatively less data on other anxiety disorders, and limited data on long-term use of antidepressants for anxiety.
Conclusions
Antidepressants are beneficial for treating anxiety disorders in late life and are generally well tolerated.
AndreasSSchulzHVolkertJPrevalence of mental disorders in elderly people: The European MentDis_ICF65+ study. Br J Psychiatry.2017; 210: 125–131.
3.
LambiaseMJKubzanskyLDThurstonRC.Prospective study of anxiety and incident stroke. Stroke.2014; 45: 438–443.
4.
ReynoldsKPietrzakRHEl-GabalawyRPrevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry.2015; 14: 74–81.
5.
AndreescuCVaronD.New research on anxiety disorders in the elderly and an update on evidencebased treatments. Curr Psychiatry Rep.2015; 17: 53.
6.
GulpersBRamakersIHamelRAnxiety as a predictor for cognitive decline and dementia: a systematic review and meta-analysis. Am J Geriatr Psychiatry.2016; 24: 823–842.
7.
ZhangXNortonJCarriereIGeneralized anxiety in community-dwelling elderly: prevalence and clinical characteristics. J Affect Disord.2015; 172: 24–29.
8.
GautamSJainAGautamMClinical practice guidelines for the management of generalised anxiety disorder (GAD) and panic disorder (PD). Indian J Psychiatry.2017; 59: S67–S73.
9.
American Geriatrics Society 2015 Beers Criteria Update Expert Panel.American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc.2015; 63: 2227–2246.
10.
GerlachLBMaustDTLeongSHFactors associated with long-term benzodiazepine use among older adults. JAMA Intern Med.2018; 178: 1560–1562.
11.
WuthrichVMRapeeRMKangasMRandomized controlled trial of group cognitive behavioral therapy compared to a discussion group for co-morbid anxiety and depression in older adults. Psychol Med.2016; 46: 785–795.
ShamseerLMoherDClarke M; PRISMA-P Group. Preferred reporting items for systematic review and metaanalysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ.2015; 349: g7647.
14.
SchuurmansJComijsHEmmelkampPMA randomized, controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults. Am J Geriatr Psychiatry.2006; 14: 255–263.
15.
BlankSLenzeEJMulsantBHOutcomes of late-life anxiety disorders during 32 weeks of citalopram treatment. J Clin Psychiatry.2006; 67: 468–472.
16.
LenzeEJMulsantBHShearMKEfficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. Am J Psychiatry.2005; 162: 146–150.
17.
DavidsonJAllgulanderCPollackMHEfficacy and tolerability of duloxetine in elderly patients with generalized anxiety disorder: a pooled analysis of four randomized, double-blind, placebo-controlled studies. Hum Psychopharmacol.2008; 23: 519–526.
18.
KatzIRReynoldsCFIIIAlexopoulosGSVenlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials. J Am Geriatr Soc.2002; 50: 18–25.
19.
AlakaKJNobleWMontejoAEfficacy and safety of duloxetine in the treatment of older adult patients with generalized anxiety disorder: a randomized, doubleblind, placebo-controlled trial. Int J Geriatr Psychiatry.2014; 29: 978–986.
20.
SheikhJISwalesPJ.Treatment of panic disorder in older adults: a pilot study comparison of alprazolam, imipramine, and placebo. Int J Psychiatry Med.1999; 29: 107–117.
21.
MokhberNAzarpazhoohMRKhajehdalueeMRandomized, single-blind, trial of sertraline and buspirone for treatment of elderly patients with generalized anxiety disorder. Psychiatry Clin Neurosci.2010; 64: 128–133.
22.
SchuurmansJComijsHEmmelkampPMLong-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders. Int Psychogeriatr.2009; 21: 1148–1159.
23.
WetherellJLPetkusAJWhiteKSAntidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults. Am J Psychiatry.2013; 170: 782–789.
24.
LenzeEJRollmanBLShearMKEscitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. JAMA.2009; 301: 295–303.
25.
HendriksGJKeijsersGPKampmanMA randomized controlled study of paroxetine and cognitive-behavioural therapy for late-life panic disorder. Acta Psychiatr Scand.2010; 122: 11–19.
26.
GouldCEO'HaraRGoldsteinMKMultimorbidity is associated with anxiety in older adults in the Health and Retirement Study. Int J Geriatr Psychiatry.2016; 31: 1105–1115.
27.
GulpersBRamakersIHamelRAnxiety as a predictor for cognitive decline and dementia: a systematic review and meta-analysis. Am J Geriatr Psychiatry. 20161; 24: 823–842.
28.
PalmerK Di Iulio F, Varsi AE,Neuropsychiatric predictors of progression from amnestic-mild cognitive impairment to Alzheimer's disease: the role of depression and apathy. J Alzheimers Dis.2010; 20: 175–183.
29.
RamosKStanleyMA.Anxiety disorders in late life. Psychiatr Clin North Am.2018; 41: 55–64.
30.
GrenierSSchuurmansJGoldfarbMScientific committee of the ESA study. The epidemiology of specific phobia and subthreshold fear subtypes in a communitybased sample of older adults. Depress Anxiety.2011; 28: 456–463.
31.
Segui'JSalvador-CarullaLMarquezMDifferential clinical features of late-onset panic disorder. J Affect Disord.2000; 57: 115–124.
32.
HallJKellettSBerriosREfficacy of cognitive behavioral therapy for generalized anxiety disorder in older adults: systematic review, meta-analysis, and meta-regression. Am J Geriatr Psychiatry.2016; 24: 1063–1073.
