Anxiety in late-life depression

Among older persons, the prevalence of a depressive disorder is high. Almost half of the depressed patients suffer from significant anxiety symptoms. In clinical practice this combination of depression and anxiety is challenging as high levels of anxiety in depression are associated with more impairment and a worse prognosis. Anxiety in late-life depression has many faces. It can represent itself in a physical or mental form, like tension or worry. With all its complications it can also be categorized as a separate anxiety disorder, like a panic disorder or a generalized anxiety disorder. Many former studies that examined this so-called ‘anxious depression’ did not differentiate between depression with high levels of anxiety and a depression with a concurrent anxiety disorder.
Our general message stresses the importance to differentiate between these depressive states. Different characteristics are found, like certain personality traits or the impact of life-events. These characteristics differentiate even further when we look at separate concurrent anxiety disorders. The combination of anxiety and depression shows a less favorable course and has a negative impact on complete remission over a period of two years. In one of the studies, we investigated the feasibility of a method of intensive repeated measurements. The patient reported about her depressive and anxiety symptoms five times a day during her daily activities. This provided a detailed insight in her symptom dynamics and stimulated a dialogue on possible treatment targets and interventions.