Depression, Anxiety, and Other Affective Disorders

  • Harold G. Koenig
  • Dan G. Blazer
  • Leslie B. Hocking


Mood disorders are the most common reversible psychiatric conditions in later life, and the vast majority are readily treated by primary care physicians and geriatricians. Depression, the prototype mood disorder, is a painful emotional experience that involves intense suffering that can drain life of meaning, excitement, and pleasure. Early epidemiologic research appeared to show that depression was unusually common among older persons.1,2 In his description of the psychosocial stages of human development, Erikson identified the struggle between integrity and despair as the primary developmental task in late life.


Bipolar Disorder Anxiety Disorder Major Depression Affective Disorder Generalize Anxiety Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Srole L, Fischer AK. The Midtown Manhattan Longitudinal Study vs. “The Mental Paradise Lost” doctrine. Arch Gen Psychiatry. 1980; 37: 209–221.PubMedCrossRefGoogle Scholar
  2. 2.
    Zung WWK. Depression in the normal aged. Psychosomatics. 1967; 8: 287–289.PubMedGoogle Scholar
  3. 3.
    Koenig HG. Depression and dysphoria among the elderly: dispelling a myth. J Fam Pract. 1986; 23: 383–385.PubMedGoogle Scholar
  4. 4.
    Weissman MM, Leaf PJ, Tischler GL, et al. Affective disorders in five United States communities. Psychol Med. 1988; 18: 141–153.PubMedCrossRefGoogle Scholar
  5. 5.
    Feldman E, Mayo R, Hawton K, et al. Psychiatric disorder in medical impatients. Q J Med. 1987; 63: 405–410.PubMedGoogle Scholar
  6. 6.
    Hagnell O, Lanke J, Rorsman B, et al. Are we entering an age of melancholy? Psychol Med. 1982; 12: 279.PubMedCrossRefGoogle Scholar
  7. 7.
    Klerman GL. The current age of youthful melancholia: evidence for increase in depression among adolescents and young adults. Br J Psychiatry. 1988; 152: 4.PubMedCrossRefGoogle Scholar
  8. 8.
    Koenig HG, Meador KG, Shelp F, et al. Depressive disorders in hospitalized medically ill patients: a comparison of young and elderly men. J Am Geriatr Soc. 1991; 39: 88 1890.Google Scholar
  9. 9.
    Weissman MM, Myers JK. Affective disorders in a United States community: the use of research diagnostic criteria in an epidemiological survey. Arch Gen Psychiatry. 1978; 31 (7): 1304.CrossRefGoogle Scholar
  10. 10.
    Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry. 1994; 51: 8–19.PubMedCrossRefGoogle Scholar
  11. 11.
    Koenig HG, Blazer DG. Epidemiology of geriatric affective disorders. Clin Geriatr Med 1992; 8: 235–251.PubMedGoogle Scholar
  12. 12.
    Blazer DG, Hughes DC, George LK. The epidemiology of depression in an elderly community population. Gerontologist. 1987; 27: 281–287.PubMedCrossRefGoogle Scholar
  13. 13.
    Blazer DG. Depression in Late Life. 2nd ed. St Louis: CV Mosby; 1993.Google Scholar
  14. 14.
    Blazer DG, Bachar JR, Manton KG. Suicide in late life: review and commentary. J Am Geriatr Soc. 1986; 34: 519525.Google Scholar
  15. 15.
    Klerman GL, Weissman MM. Increasing rates of depression. JAMA 1989; 261: 2229–2235.PubMedCrossRefGoogle Scholar
  16. 16.
    Koenig HG, Meador K, Cohen HJ, et al. Depression in elderly men hospitalized with medical illness. Arch Intern Med. 1988; 148: 1929–1936.PubMedCrossRefGoogle Scholar
  17. 17.
    Hyer L, Blazer DG. Depressive symptoms: impact and problems in long term care facilities. Int J Behav Geriatr. 1982; 1 (3): 33–35.Google Scholar
  18. 18.
    Parmelee PA, Katz IR, Lawton MP. Depression among institutionalized aged: assessment and prevalence estimation. J Gerontol. 1989; 44: M22 - M29.PubMedCrossRefGoogle Scholar
  19. 19.
    Weissman MM, Bruce ML, Leaf PJ, et al. Affective disorders. In: Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press; 1991: 53.Google Scholar
  20. 20.
    Rovner BW, German P, Brant LJ, et al. Depression and mortality in nursing homes. JAMA. 1991; 265: 993996.Google Scholar
  21. 21.
    Koenig HG, Cohen HJ, Blazer DG, et al. A brief depression scale for detecting major depression in the medically ill hospitalized patient. Int J Psychiatry Med. 1992; 22: 183195.Google Scholar
  22. 22.
    Koenig HG, Blazer DG, Ford SM. Should physicians screen for depression in elderly medical inpatients? Results of a decision analysis. Int J Psychiatry Med. 1993; 23: 211–235.CrossRefGoogle Scholar
  23. 23.
    Murphy E, Smith R, Lundesay J, et al. Increased mortality rates in late-life depression. Br J Psychiatry. 1988; 152: 347353.Google Scholar
  24. 24.
    Koenig HG, Shelp F, Goli V, et al. Survival and healthcare utilization in elderly medical inpatients with major depression. J Am Geriatr Soc. 1989; 37: 599–606.PubMedGoogle Scholar
  25. 25.
    Parmelee PA, Katz IR, Lawton MP. Depression and mortality among institutionalized aged. J Gerontol. 1992; 47: P3 - P10.PubMedCrossRefGoogle Scholar
  26. 26.
    Hopkinson G. A genetic study of affective illness in patients over 50. Br J Psychiatry. 1964; 110: 244–254.PubMedCrossRefGoogle Scholar
  27. 27.
    Robinson DS, Davies JM, Nies A, et al. Relation of sex and aging to monoamine oxidase activity of human plasma and platelets. Arch Gen Psychiatry. 1971; 24: 536–541.PubMedCrossRefGoogle Scholar
  28. 28.
    Goldberg EL, Van Natta P, Comstock GW. Depressive symptoms, social networks and social support of elderly women. Am J Epidemiol. 1985; 121: 448–456.PubMedGoogle Scholar
  29. 29.
    Murrell SA, Himmelfarb S, Wright K. Prevalence of depression and its correlates in older adults. Am J Epidemiol. 1983; 117: 173–185.PubMedGoogle Scholar
  30. 30.
    Stallones L, Marx MB, Garrity TF. Prevalence and correlates of depressive symptoms among older U.S. Adults. Am J Prey Med. 1990; 6: 295–303.Google Scholar
  31. 31.
    Meyers BS, Kalayam B, Mei-Tal V. Late-onset delusional depression: a distinct clinical entity? J Clin Psychiatry. 1984; 45: 347–349.PubMedGoogle Scholar
  32. 32.
    George LK, Blazer DG, Hughes DC, et al. Social support and the outcome of major depression. Br J Psychiatry. 1989; 154: 478–485.PubMedCrossRefGoogle Scholar
  33. 33.
    Koenig HG, Westlund RE, George LK, et al. Abbreviating the Duke Social Support Index for use in chronically ill older adults. Psychosomatics. 1993; 34: 61–69.PubMedCrossRefGoogle Scholar
  34. 34.
    Clayton P. Bereavement and depression. J Clin Psychiatry. 1990; 51 (July suppl): 34.PubMedGoogle Scholar
  35. 35.
    Koenig HG, Kvale JN, Ferrel C. Religion and well-being in later life. Gerontologist. 1988; 28: 18–28.PubMedCrossRefGoogle Scholar
  36. 36.
    Koenig HG, Cohen HJ, Blazer DG, et al. Religious coping and depression in elderly hospitalized medically ill men. Am J Psychiatry. 1992; 149: 1693–1700.PubMedGoogle Scholar
  37. 37.
    Koenig HG, George LK, Siegler I. The use of religion and other emotion-regulating coping strategies among older adults. Gerontologist. 1988; 28: 303–310.PubMedCrossRefGoogle Scholar
  38. 38.
    Koenig HG, Cohen HJ, Blazer DG, et al. Cognitive symptoms of depression and religious coping in elderly medical patients. Psychosomatics. 1995; 36: 369–375.PubMedCrossRefGoogle Scholar
  39. 39.
    Idler EL, Kasl SV. Religion, disability, depression, and the timing of death. Am J Sociol. 1992; 97: 1052–1079.CrossRefGoogle Scholar
  40. 40.
    Idler EL. Religious involvement and the health of the elderly. Social Forces. 1987; 66: 226–238.Google Scholar
  41. 41.
    Pressman P, Lyons JS, Larson DB, et al. Religious belief, depression, and ambulation status in elderly women with broken hips. Am J Psychiatry. 1990; 147: 758–760.PubMedGoogle Scholar
  42. 42.
    Koenig HG. Research on Religion and Aging. Westport, CT: Greenwood Press; 1995.Google Scholar
  43. 43.
    Lazarus R. Psychological stress and coping in adaptation and illness. Int J Psychiatry Med. 1974; 5: 321–333.PubMedCrossRefGoogle Scholar
  44. 44.
    Olinger L, Kuiper N, Shaw B. Dysfunctional attitudes and stressful life events: an interactive model of depression. Cognitive Ther Res. 1987; 11: 25–40.CrossRefGoogle Scholar
  45. 45.
    Holroyd K, Lazarus R. Stress, coping and somatic adaptation. In: Goldberger L, Breznitz S, eds. Handbook of Stress. New York: Free Press; 1982.Google Scholar
  46. 46.
    Bombardier C, D’Amico C, Jordan J. The relationship of appraisal and coping to chronic illness adjustment. Behav Res Ther. 1990; 28: 297–304.PubMedCrossRefGoogle Scholar
  47. 47.
    Smith T, Follick M, Ahern D, et al. Cognitive distortion and disability in chronic low back pain. Cognitive Ther Res. 1986; 10: 201–210.CrossRefGoogle Scholar
  48. 48.
    Holroyd K, Andrasik F. Do the effects of cognitive therapy endure? A two-year followup of tension headache suffers treated with cognitive therapy or biofeedback. Cognitive Ther Res. 1982; 6: 325–334.CrossRefGoogle Scholar
  49. 49.
    Gianturco DT, Busse EW. Psychiatric problems encountered during a long-term study of normal ageing volunteers. In: Issacs AD, Post F, eds. Studies in Geriatric Psychiatry. New York: John Wiley; 1978: 1–16.Google Scholar
  50. 50.
    Koenig HG, Cohen HJ, Blazer DG, et al. Profile of depressive symptoms in younger and older medical inpatients with major depression. J Am Geriatr Soc. 1993; 41: 1169–1176.PubMedGoogle Scholar
  51. 51.
    Verwoerdt A. Geropsychiatry. Baltimore: Williams & Wilkins; 1976.Google Scholar
  52. 52.
    De Alarcon R. Hypochondriasis and depression in the aged. Gerontology. 1964; 6: 266–277.Google Scholar
  53. 53.
    Post F. The functional psychoses. In: Isaacs AD, Post F, eds. Studies in Geriatric Psychiatry. New York: John Wiley; 1978: 77.Google Scholar
  54. 54.
    Shulman KI. Mania in old age. In: Murphy E, ed. Affective Disorders in the Elderly. Edinburgh: Churchill-Livingstone; 1986.Google Scholar
  55. 55.
    Post F. Functional disorders II. Treatment and its relationship to causation. In: Levy R, Post F, eds. The Psychiatry of Late Life. London: Blackwell Scientific Publications; 1982.Google Scholar
  56. 56.
    Shulman KI. The influence of age and ageing on manic disorder. Int J Geriatr Psychiatry. 1989; 4: 63–65.CrossRefGoogle Scholar
  57. 57.
    Young RC, Klerman GL. Mania in late life: focus on age at onset. Am J Psychiatry. 1992; 149: 867–876.PubMedGoogle Scholar
  58. 58.
    Tohen M, Shulman KI, Satlin A. First-episode mania in late life. Am J Psychiatry. 1994; 151: 130–132.PubMedGoogle Scholar
  59. 59.
    Sweer L, Martin DC, Ladd RA, et al. The medical evaluation of elderly patients with major depression. J Gerontol. 1988; 43: M53 - M58.PubMedCrossRefGoogle Scholar
  60. 60.
    Cavan RS. Suicide. Chicago: University of Chicago Press; 1928: 279–287.Google Scholar
  61. 61.
    MacKenzie TB, Popkin MK. Suicide in the medical patient. Int J Psychiatry Med 1987; 17: 3–22.PubMedCrossRefGoogle Scholar
  62. 62.
    Koenig HG. Aging and God. New York: Haworth Press; 1994.Google Scholar
  63. 63.
    Koenig HG, Breitner J. Antidepressant use in the medically ill older person. Psychosomatics. 1990; 31: 22–32.PubMedCrossRefGoogle Scholar
  64. 64.
    Beck AT, Rush J, Shaw B, et al. Cognitive Therapy of Depression. New York: Guilford; 1979.Google Scholar
  65. 65.
    Lewinsohn P. A behavioral approach to depression. In: Friedman R, Katz M, eds. The Psychology of Depression: Contemporary Theory and Research. New York: John Wiley; 1974: 157–176.Google Scholar
  66. 66.
    Horowitz M, Kaltreider N. Brief therapy of the stress response syndrome. Psychiatr Clin North Am. 1979; 2: 365377.Google Scholar
  67. 67.
    Thompson LW, Gallagher D, Breckenridge JS. Comparative effectiveness of psychotherapies for depressed elders. J Consult Clin Psychol. 1987; 55: 385–390.PubMedCrossRefGoogle Scholar
  68. 68.
    Arean PA, Perri MG, Nezu AM, et al. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychol. 1993; 61: 1003–1010.PubMedCrossRefGoogle Scholar
  69. 69.
    Myers WA. New Techniques in the Psychotherapy of Older Patients. Washington, DC: American Psychiatric Press; 1991.Google Scholar
  70. 70.
    Marmar CR, Horowitz MJ, Weiss DS, et al. A controlled trial of brief psychotherapy and mutual-help group treatment of conjugal bereavement. Am J Psychiatry. 1988; 145: 203–209.PubMedGoogle Scholar
  71. 71.
    Nies A, Robinson DS, Friedman MJ, et al. Relationship between age and tricyclic antidepressant pharmacokinetics and plasma levels. Am J Psychiatry. 1977; 134: 790793.Google Scholar
  72. 72.
    Greden JF. Antidepressant maintenance medications: when to discontinue and how to stop. J Clin Psychiatry. 1993; 54 (suppl 8): 39–45.PubMedGoogle Scholar
  73. 73.
    Tyrer P, Murphy S. The place of benzodiazepines in psychiatric practice. Br J Psychiatry. 1987; 151: 719–723.PubMedCrossRefGoogle Scholar
  74. 74.
    Greenblatt DJ, Shader RI, Abernathy DR. Current status of benzodiazepines: clinical use of benzodiazepines. N Engl J Med. 1983; 309: 410–405.PubMedCrossRefGoogle Scholar
  75. 75.
    Katon W, Raskind M. Treatment of depression in the medically ill elderly with methylphenidate. Am J Psychiatry. 1980; 137: 963–965.PubMedGoogle Scholar
  76. 76.
    Millard PH. Depression in old age. Br Med J. 1983; 287: 375–376.CrossRefGoogle Scholar
  77. 77.
    Baldwin RC, Jolley DJ. The prognosis of depression in old age. Br J Psychiatry. 1986; 149: 574–583.PubMedCrossRefGoogle Scholar
  78. 78.
    Post F. The management and nature of depressive illness in late life: a follow-through study. Br J Psychiatry. 1972; 121: 393–404.PubMedCrossRefGoogle Scholar
  79. 79.
    Murphy E, Smith R, Lindesay J, et al. Increased mortality rates in late-life depression. Br Psychiatry. 1988; 152: 347353.Google Scholar
  80. 80.
    Murphy E. The prognosis of depression in old age. Br J Psychiatry. 1983; 142: 111–119.PubMedCrossRefGoogle Scholar
  81. 81.
    Koenig HG, Goli V, Shelp F, et al. Major depression in hospitalized medically ill men: documentation, treatment, and prognosis. Int J Geriatr Psychiatry. 1992; 7: 25–34.CrossRefGoogle Scholar
  82. 82.
    Reynolds CF, Frank E, Perel JM, et al. Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report. Am J Psychiatry. 1992; 149: 1687–1692.PubMedGoogle Scholar
  83. 83.
    Hinrichsen GA. Recovery and relapse from major depressive disorder in the elderly. Am J Psychiatry. 1992;. 149: 1575–1579.Google Scholar
  84. 84.
    Stoudemire A, Hill CD, Morris R, et al. Long-term affective and cognitive outcome in depressed older adults. Am J Psychiatry. 1993; 150: 896–900.PubMedGoogle Scholar
  85. 85.
    Hughes DC, Demallie D, Blazer DG. Does age make a difference in the effects of physical health and social support on the outcome of a major depressive episode? Am J Psychiatry. 1993; 150: 728–733.PubMedGoogle Scholar
  86. 86.
    Shulman KI, Tohen M, Stalin A, et al. Mania compared with unipolar depression in old age. Am J Psychiatry. 1992; 149: 341–345.PubMedGoogle Scholar
  87. 87.
    Regier DA, Boyd JH, Burke JD, et al. One month prevalence of mental disorders in the United States. Arch Gen Psychiatry. 1988; 45: 977–986.PubMedCrossRefGoogle Scholar
  88. 88.
    Sheikh JI. Anxiety and its disorders in old age. In: Birren J, Sloane R, Cohen G, eds. Handbook of Mental Health and Aging. 2nd ed. San Diego: Academic Press; 1992: 409–432.Google Scholar
  89. 89.
    Stein MB, Heuser IJ, Juncos JL, et al. Anxiety disorders in patients with Parkinson’s disease. Am J Psychiatry. 1990; 147: 217–220.PubMedGoogle Scholar
  90. 90.
    Karajgi B, Rifkin A, Doddi S, et al. The prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease. Am J Psychiatry. 1990; 147: 200–201.PubMedGoogle Scholar
  91. 91.
    Wands K, Merskey H, Hachinski V, et al. A questionnaire investigation of anxiety and depression in early dementia. J Am Geriatr Soc. 1990; 38: 535–538.PubMedGoogle Scholar
  92. 92.
    Jenike MA. Anxiety disorders of old age. In: Jenike MA, ed. Geriatric Psychiatry and Psychopharmacology. Chicago: Year Book Medical Publishers; 1989: 248–271.Google Scholar
  93. 93.
    Alexopoulas GS. Anxiety and depression in the elderly. In: Salzman C, Lebowitz B, eds. Anxiety Disorders in the Elderly: Treatment and Research. New York: Springer; 1991: 131–150.Google Scholar
  94. 94.
    Blazer DG, Hughes D, George LK, et al. Generalized anxiety disorder. In: Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press; 1991: 180–203.Google Scholar
  95. 95.
    Eaton WW, Dryman A, Weissman MM. Panic and phobia. In: Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press; 1991: 155–179.Google Scholar
  96. 96.
    Sheikh J, King R, Taylor CB. Comparative phenomenology of early-onset versus late-onset panic attacks: a pilot survey. Am J Psychiatry. 1991; 148: 1231–1233.PubMedGoogle Scholar
  97. 97.
    Beitman BD, Mukerji V, Alpert M, et al. Panic disorder in cardiology patients. Psychiatr Med. 1990; 8: 67–81.PubMedGoogle Scholar
  98. 98.
    Beitman BD, Kushner M, Grossberg GT. Late onset panic disorder: evidence from a study of patients with chest pain and normal cardiac evaluations. Int J Psychiatry Med. 1991; 21: 29–35.PubMedCrossRefGoogle Scholar
  99. 99.
    Blazer DG, George LK, Hughes D. The epidemiology of anxiety disorders: an age comparison. In: Salzman C, Lebowitz B, eds. Anxiety Disorders in the Elderly: Treatment and Research. New York: Springer; 1991: 17–30.Google Scholar
  100. 100.
    Karno M, Golding JM. Obsessive compulsive disorder. In: Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press; 1991: 204–219.Google Scholar
  101. 101.
    Abrams R. Anxiety and personality disorders. In: Sadavoy J, Lazarus L, Jarvik L, eds. Comprehensive Review of Geriatric Psychiatry. Washington, DC: American Psychiatric Association; 1991: 369–376.Google Scholar
  102. 102.
    Jacobsen E. Progressive Relaxation. 2nd ed. Chicago: University of Chicago Press; 1938.Google Scholar
  103. 103.
    Gift AG, Moore T, Soeken K. Relaxation to reduce dyspnea and anxiety in COPD patients. Nurs Res. 1992; 41: 242–246.PubMedCrossRefGoogle Scholar
  104. 104.
    Holland JC, Morrow GR, Schmale A, et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol. 1991; 9: 1004–1011.PubMedGoogle Scholar
  105. 105.
    Wolpe J. The Practice of Behavior Therapy 2nd ed. New York: Pergamon Press; 1973.Google Scholar
  106. 106.
    Hussian RA. Geriatric Psychology: A Behavioral Perspective. New York: Van Nostrand Reinhold; 1981.Google Scholar
  107. 107.
    Salzman C, Lebowitz BD. Anxiety in the Elderly. New York: Springer; 1991: 149–173.Google Scholar
  108. 108.
    Salzman C. Treatment of anxiety. In: Salzman C, ed. Clinical Geriatric Psychopharmacology. 2nd ed. Baltimore: Williams and Wilkins; 1992: 189–212.Google Scholar
  109. 109.
    Abernathy DR, Greenblatt DJ, Divoll M, et al. Pharmacokinetics of alprazolam. J Clin Psychiatry. 1983; 44: 45–47.Google Scholar
  110. 110.
    Pinsker H, Suljaga-Petchel K. Use of benzodiazepines in primary care geriatric patients. J Am Geriatr Soc. 1984; 32: 595–598.PubMedGoogle Scholar
  111. 111.
    Ray WA, Griffin MR, Schaffner W, et al. Psychotropic drug use and the risk of hip fracture. N Engl J Med. 1987; 316: 363–369.PubMedCrossRefGoogle Scholar
  112. 112.
    Guilleminault C. Benzodiazepines, breathing, and sleep. Am J Med. 1990; 88 (3A): 25S - 28S.PubMedCrossRefGoogle Scholar
  113. 113.
    Salzman C. Anxiety in the elderly: treatment strategies. J Clin Psychiatry. 1990; 51 (suppl 10): 18–21.PubMedGoogle Scholar
  114. 114.
    Bohm C, Robinson DS, Gammans RE, et al. Buspirone therapy in anxious elderly patients: a controlled clinical trial. J Clin Psychopharmacol. 1990; 10 (suppl 3): 47S - 51S.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Harold G. Koenig
  • Dan G. Blazer
  • Leslie B. Hocking

There are no affiliations available

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