C. Altamura
Department of Clinical Psychiatry, Laboratory of Clinical Neuropsychopharmacology, University of Milan, 20122 Milan, Italy
Depression and anxiety are phenomena frequently experienced by the elderly. The use of antidepressant, anxiolytic, and hypnotic drugs is an important indication of this, since its frequency is extremely high just past the age of 65 (especially in women), and the suicide rate reaches its peak at about 70 years (5). Very often these phenomena are mixed in the form usually termed anxious-depressive syndrome, in which a psychopathological state is defined in purely phenomenological terms and in which the anxious and depressive components are mixed, with more or less pronounced somatic complaints and insomnia. In late life, this syndrome is characterized by a higher etiopathogenetic heterogeneity, but also by a more evident complexity in semiological, diagnostic, nosographic, and, accordingly, therapeutic terms. From an etiopathogenetic point of view, in the elderly, depression and anxiety generally arise from a mixture of sociogenetic, psychogenetic, and biological factors difficult to elucidate. Therefore, any attempt to perform a subdivision in nosographic terms of the two major entities, the endogenous depressive forms and the reactive forms, using, for example, the Newcastle Inventory Scale (9), is virtually impossible, since there is a huge imbalance in favor of the reactive type due to the burden of sociogenetic and environmental factors. From the semiological perspective, the symptoms of both the anxious and depressive series are variable, often more or less partially masked, generally anomalous versus those observed in the adult. Thoughts often appear to be focused on the individual’s objective physical troubles, in the sense of minus or of various functional changes (reduced deambulation, prostatic hypertrophy, aches, etc.), with a very intense affective participation. These peculiar ideoaffective processes could be the single "signs" of a latent depressive situation and the diagnostic difficulties of these forms arise, indeed, from these phenomenological peculiarities. From the therapeutic point of view, functional impairment at cerebral and extracerebral levels, as well as changes in some physiological parameters regulating the kinetic disposition of the various compounds into the body, make the use of psychotropic drugs particularly complex.