Onset of anxiety and depression in the aging population: comparison of risk factors in a 9-year prospective study.

OBJECTIVES: To study the onset and compare risk factors for pure depression (DEP), pure anxiety (ANX), and comorbid anxiety-depression (ANXDEP) in the aging population. DESIGN: Prospective study with 3-year intervals over a 9-year period. SETTING: Data of the Longitudinal Aging Study Amsterdam were used, which is a population-based study among older adults (55-85 years at baseline). PARTICIPANTS: Older adults free of depression and anxiety at baseline (N = 1,712). MEASUREMENTS: Clinically relevant levels of depression and anxiety were measured with the Center for Epidemiologic Studies Depression scale> or =16 and Hospital Anxiety and Depression Scale > or =7, respectively. A broad range of potential sociodemographic, health, and psychosocial risk factors for anxiety and/or depression were examined by using polytomous logistic regression analyses. RESULTS: Within 9 years, 184 subjects (10.8%) developed DEP, 93 (5.4%) ANX, and 103 (6.0%) ANXDEP. Concerning sociodemographics, higher age and lower educational level were predictors for DEP. Health indicators were predictive for DEP and ANXDEP but not for ANX. Depressive symptoms at baseline were predictive for DEP, whereas initial anxiety symptoms were predictive for ANX and ANXDEP. Neuroticism increased the risk of DEP and ANXDEP. Mixed effects of psychosocial variables were found: DEP was associated with recent widowhood, whereas ANX and ANXDEP were associated with other life events such as having an ill partner. CONCLUSION: Although onset of ANXDEP demonstrated communality in risk factors, comparing risk factors associated with DEP and ANX revealed more differences than similarities. This underlines the need to distinguish anxiety from depression in preventive strategies.

Risk factors for anxiety and depression in the elderly: a review.

BACKGROUND: Although a number of studies have examined risk factors for anxiety and depression at a later age, there have been no systematic comparisons of risk profiles across studies. Knowledge on such risk profiles may further our understanding of both the etiology and early recognition of these highly prevalent disorders. This paper gives a comprehensive overview and compares risk factors associated with anxiety and depression in the elderly. METHODS: The databases MEDLINE, PsycINFO and Sociological Abstracts were systematically searched, and relevant English-language articles from January 1995 to December 2005 were reviewed. Cross-sectional and longitudinal studies on risk factors in elderly from a community or primary care setting were included. The associations between risk factors and pure anxiety or depressive symptoms or disorders were summarized and compared. RESULTS: The abstracted risk factors from studies on anxiety (N=17) and depression (N=71) were clustered into the categories biological, psychological and social. Although risk factors for anxiety and depression showed many similarities, some differences were found. Biological factors may be more important in predicting depression, and a differential effect of social factors on depression and anxiety was found. LIMITATION: Due to a high heterogeneity between studies, no meta-analysis could be conducted. CONCLUSIONS: There is considerable overlap between the risk profiles for anxiety and depression in the elderly, which suggests a dimensional approach on the interrelationship between anxiety and depression is more appropriate. To improve the recognition and preventive mental health programs, a clearer understanding of differentiating etiological factors will be needed.

Lithium augmentation compared with phenelzine in treatment-resistant depression in the elderly: an open, randomized, controlled trial.

BACKGROUND: Up to a third of elderly patients with major depressive disorder do not respond to a first course of treatment with an antidepressant. There is a lack of controlled studies evaluating therapies for treatment-resistant depression in late-life depression, and no randomized controlled studies assessing the efficacy and tolerability of lithium augmentation in elderly patients have been published. METHOD: Twenty-nine elderly inpatients with major depressive disorder according to DSM-IV criteria who had previously failed to respond to 1 or more adequate trials with a tricyclic antidepressant or venlafaxine were included in a 6-week, open, randomized, controlled study with a 2-year follow-up. Subjects received either lithium augmentation or the monoamine oxidase inhibitor phenelzine. The primary outcome criterion was remission, defined as a final score of less than or equal to 10 on the Montgomery-Asberg Depression Rating Scale (MADRS). Response was defined as at least 50% reduction on the MADRS or the Hamilton Rating Scale for Depression (HAM-D). RESULTS: Twenty-eight subjects completed the trial. Remission on the MADRS was achieved by 33.3% of the lithium patients, compared with none of the phenelzine patients (p = .042). Response also showed a difference in favor of lithium augmentation (p = .035 on both the MADRS and the HAM-D). Overall tolerability was good, with no dropouts due to side effects. Subjective memory impairment was more prevalent among patients receiving phenelzine (p = .002), and tremors were significantly more prevalent among patients receiving lithium (p = .002). During the 2-year follow-up, 25 patients (86.2%) did achieve remission, particularly on prolonging the lithium treatment (5 patients) or on lithium augmentation to phenelzine (5 patients). CONCLUSION: Lithium was more effective than phenelzine in elderly patients with treatment-resistant major depressive disorder, while tolerance of both treatments was remarkably good in this group of elderly inpatients with many comorbid medical disorders. CLINICAL TRIALS REGISTRATION: Controlled-trials.com identifier is RCTN93105957.