Over 60 with anxiety? Should you opt for therapy or medication?
Medication is often the go-to treatment for anxiety disorders for Australians over 60, but new research suggests a better way.
Older people with anxiety disorders have better recovery outcomes using psychological therapy than if they take medications, even though pharmacological treatments are more likely to be prescribed, new research finds.
The study explodes the myth that psychological treatment is ineffective for older adults, countering a view among many clinicians and older patients themselves that you can’t teach an old dog new tricks, its author, Macquarie University associate professor Carly Johnco, says.
With anxiety disorders affecting about one in 10 Australians aged 60 and over, Associate Professor Johnco’s study found that on average 53 per cent of older people recovered from their anxiety disorder after receiving cognitive behavioural therapy, compared to 36 per cent after medication treatment.
The analysis of 22 trials, covering more than 2300 people aged over 60, also showed they were seven times more likely to recover from anxiety using CBT than if left untreated.
This compared to those on medication, who were twice as likely to recover than those who were on a placebo, the study, published in The American Journal of Geriatric Psychiatry, found.
“It is often assumed that it’s normal for people to have a bit more anxiety at an older age, and when it comes to using psychological treatment that you can’t teach an old dog new tricks,” Associate Professor Johnco said.
“So anxiety is under-recognised, seen as a normal part of ageing, and even when they are referred to treatment they are disproportionately given medication.
“A person might see their GP, and they are already being prescribed a range of other medications, so the view might be what’s one more.
“This review challenges the outdated idea that older people don’t do therapy or can’t change. There is substantial untapped potential for using psychological therapies like CBT to treat anxiety in older adults.”
Australian clinical guidelines encourage non-pharmacological options over medication for anxiety and depression among older adults.
But the Australian Institute of Health and Welfare reports that approximately one in four Australians aged over 65 years were prescribed antidepressants in 2022–23, compared with one in seven across the general population.
This is despite older adults reporting lower rates of depression and anxiety than younger people.
And the National Study of Mental Health and Wellbeing reports that while 21 per cent of all age groups with a mental health disorder had accessed a psychologist, it was 13 per cent for over-65s.
Practising psychiatrist at The Alfred in Melbourne, Paul Denborough, said there was a large focus on finding therapy options for youth mental health, but older people weren’t receiving the same attention.
“I’m also concerned about the prescription of SSRI’s (selective serotonin reuptake inhibitors), which recent research has shown may be a risk factor for dementia,” Dr Denborough said.
“Australia is the second highest prescriber of SSRIs in the world and I don’t think that’s a good thing.”
Associate Professor Johnco said the study showed both types of treatment for anxiety could be effective, but older people have not had clear data about recovery on which to base their treatment decision.
“Hopefully this study arms them with the information they need to make informed choices based on their individual needs, preferences and medical history,” she says.
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