Anxiety and depression in late life

Although the prevalence of anxiety and depressive disorders among community-residing older adults is lower than in middle-aged persons, there are high rates of both in older people admitted to general hospitals, those receiving domiciliary care, and those residing in nursing homes. High rates of anxiety and depression also occur in older people with mild cognitive impairment and dementia. Evidence-based psychological and pharmacological treatments are available for the treatment of anxiety and depressive disorders in older people. These two treatment modalities show approximately equivalent efficacy, although drug treatments are generally preferred for older people with more severe depression and psychological treatments are generally preferred for older people with mild to moderate anxiety. Both interpersonal psychotherapy and cognitive behavioral therapy are effective in older people, although the latter is in more widespread use. Rational drug treatment of anxiety and depression in older people mainly involves the use of antidepressant medication, particularly the selective serotonin reuptake inhibitors. At present, it is unclear whether antidepressant medication is effective in patients with both dementia and depression. Electroconvulsive therapy remains an appropriate option for older depressed patients who have stopped eating or drinking, have psychotic symptoms, or are actively suicidal. Combination treatment with antidepressant medication and one of the psychological treatments is recommended although there is only limited supporting evidence in older people. Newer brain stimulation treatments such as transcranial magnetic stimulation are being trialed in older people with anxiety and depression, but in many places their use remains investigational. Prevention of both anxiety and depression in older people does seem feasible and a stepped-care program has shown promising results