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Pharmacological Management of Anxiety and Depression in Older People

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Mental Health and Older People

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Abstract

Depressive and anxiety disorders are commonly encountered in older patients in primary care. They may present with psychological or physical symptoms or a combination and may impact on the course and management of coexisting physical disorders. Depression and anxiety often coexist; up to a quarter of older people with anxiety disorders also meet criteria for major depression and the presence of anxiety in depressed patients is associated with a greater risk of relapse. Not surprisingly, therefore, their causes and treatments also overlap. Most anxiety disorders are diagnosed by the age of 40, but a few people will develop them after 65 years; generalised anxiety and social phobia appear to be the more common disorders in older people. They typically run a cyclical course and are unlikely to remit completely, even with long-term treatment. Around two thirds of people with Alzheimer’s disease experience anxiety symptoms and 5–6 % have diagnosable generalised anxiety disorder so it is important to assess for cognitive impairment when deciding on management. Risk factors for anxiety in older people include female gender, multiple physical conditions, residing in a care home, and physical disability. Anxiety is specifically linked to thyroid problems, respiratory and gastrointestinal disorders, and arthritis; anxiety disorders may also precede the onset of physical illness and worsen quality of life and disability.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, Warneford Hospital, Oxford, Oxfordshire, UK

    Philip Wilkinson BM, BS, FRCPsych & Sophie Behrman BA, BMBCh, MRCPsych

Authors
  1. Philip Wilkinson BM, BS, FRCPsych
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  2. Sophie Behrman BA, BMBCh, MRCPsych
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Corresponding author

Correspondence to Philip Wilkinson BM, BS, FRCPsych .

Editor information

Editors and Affiliations

  1. Keele University, Newcastle Under Lyme, Staffordshire, United Kingdom

    Carolyn A. Chew-Graham

  2. Keele University, Keele, Staffordshire, United Kingdom

    Mo Ray

Appendix 9.1: Suggested Reading for Patients

Appendix 9.1: Suggested Reading for Patients

Age UK website, including printable factsheets on depression: www.ageuk.org.uk/health-wellbeing/conditions-illnesses/depression/

Mind website, including factsheets on depression and anxiety: www.mind.org.uk/information-support/types-of-mental-health-problems/depression

NHS Choices website: www.nhs.uk/conditions

1.1 Appendix 9.2: Recommended Reading for Prescribers

Cleare A, Pariante C, Young AH, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015;29(5):459–525.

Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol (Oxf). 2014;28(5):403–39.

Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry. 11th edn. Chichester: Wiley-Blackwell; 2012.

Stahl S. The prescriber’s guide: antidepressants. New York: Cambridge University Press; 2006.

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Wilkinson, P., Behrman, S. (2016). Pharmacological Management of Anxiety and Depression in Older People. In: Chew-Graham, C., Ray, M. (eds) Mental Health and Older People. Springer, Cham. https://doi.org/10.1007/978-3-319-29492-6_9

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  • DOI: https://doi.org/10.1007/978-3-319-29492-6_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29490-2

  • Online ISBN: 978-3-319-29492-6

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