Martha Rial, Post-Gazette
	Dr. Eric Lenze, right, listens to E. Robert Derr Jr. of McCandless, while gathering information for a study about anxiety in senior citizens run by UPMC's Late Life Mood Disorders Program in Oakland. Put on the Silver Sneakers

When a colleague suggested that he investigate anxiety disorders in older people, Dr. Eric Lenze was initially skeptical.

"I think I shared the belief of most people in the field that it didn't seem to be much of a problem," he recalled.

But Dr. Lenze, a geriatric psychiatrist at the University of Pittsburgh School of Medicine, soon concluded that the subject merited more attention.

He is currently leading a study to assess the effect of an antidepressant medication on late-life anxiety. The project, funded by the National Institute of Mental Health, is believed to be the largest treatment study to date of generalized anxiety disorder in older adults.

So far, about 60 people have participated in the study, which began last year. It will continue until 176 people have enrolled, said coordinator Krissy Koenig.

About 7 percent of older adults have generalized anxiety disorder, making it one of the most common mental health problems, Dr. Lenze said. The main symptoms are excessive worry or nervousness. Some patients also complain of fatigue, an inability to concentrate, low energy, muscle tension, restlessness or trouble sleeping.

Patients may struggle with anxiety for many years, yet it is often undetected, he said. Older adults may be reluctant to admit they have the problem and their doctors usually don't ask.

Often, older people don't even consider treatment, thinking their anxiety is "a personality trait or a natural reaction to negative events associated with aging," said Dr. Julie Wetherell, a psychologist and assistant professor of psychiatry at the University of California, San Diego.

While some level of anxiety can be helpful with certain tasks -- preparing for a test, for example -- that beneficial effect doesn't seem to occur in older people, Dr. Lenze said. Instead, anxiety seems to hinder memory, attention and the ability to solve problems.

Untreated anxiety also can prompt people to avoid social interaction or activities they once enjoyed.

A 2004 study in the Netherlands even found an increased mortality risk among older men with anxiety problems, Dr. Wetherell noted.

But despite its serious effects, relatively little research has been done on anxiety disorders in older people, she said.

Research in late-life anxiety treatment is 15 to 20 years behind that of late-life depression, Dr. Lenze said.

His study, called Relief from Anxiety in Older Adults, randomly assigns older patients to one of two groups. One group receives the drug escitalopram, an antidepressant whose brand name is Lexapro, for 12 weeks. The other group receives a placebo. Patients receive regular assessments of their mood, mental functioning and other health conditions. All patients are then treated with Lexapro for another 12 weeks.

Lexapro, a selective serotonin reuptake inhibitor, or SSRI, was chosen because it is well tolerated and generally doesn't interact with other medications, he said.

While the drug has been approved for treating anxiety, earlier studies about its effectiveness were conducted in younger people, Dr. Lenze said.

E. Robert Derr Jr. said he has felt better since participating in the study.

During an assessment session with research associate Caroline Ciliberti, Mr. Derr, 78, of McCandless, said he usually has a positive outlook but has some concerns over his medical condition. He received a heart transplant years ago and sees 23 doctors for a variety of health problems.

"You have to develop some anxiety over those things. It's a worry to you," he said.

Dorcas Amaker, who completed the study in January, said taking Lexapro appeared to help. Ms. Amaker, 79, of Homewood, said she had been anxious about problems in her neighborhood, had trouble sleeping and wondered if she was developing dementia.

She felt the treatment "relaxed me to the extent that I was sleeping better. I felt I was under control and could tolerate more disappointments."

Other patients also have shown a benefit, Dr. Lenze said. He noted that one local attorney who had planned to retire decided to keep working after treatment with the drug.

An earlier study he led showed relief from anxiety from taking a similar antidepressant. Sixty-five percent of the 34 participants treated with citalopram, whose brand name is Celexa, improved compared to 24 percent treated with placebo.

Some people do not get significantly better with drug treatment alone, Dr. Lenze noted. He and Dr. Wetherell plan to begin another study this fall to determine whether patients could have a greater response by combining drug treatment with a type of talk therapy known as cognitive behavior therapy or CBT.

Dr. Wetherell noted that CBT, which helps patients recognize negative patterns of thinking and reacting and replace them with more productive alternatives, can help patients even after treatment has ended. By then, they have learned skills that they can apply to anxiety-provoking situations.

People 60 and older are still being accepted into the Relief from Anxiety in Older Adults study. For information, call 412-246-6006.