I should like to discuss briefly a particularly important topic concerning the relationship between depression and anxiety in the elderly. It is well known that these experiences could be interpreted as the expression of the same dysthymic spectrum (dimensionalist view) or as manifestation (mutually distinct) with dif­ferent etiopathogenesis, clinical course, and outcome, which could be occasionally coincident in certain periods of life (dualist view). In the aged patient, anxiety almost invariably accompanies the depressive symptoms. This anxiety could be regarded as a response elicited by stress and conflictuality that the subject un­dergoes because of various reasons, such as changes in life-style, etc. In other words, anxiety can be considered as a sort of aspecific "background noise" in the existential experience of the subject. However, in some cases it could acquire a deeper and more specific value; it becomes a "vital anxiety," as described by Lopez-Ibor (6), with a feature of biologically determined endoge-nicity, which could be only apparently related to a conflict situation. It seems to be coincident with the depressive phenomena itself in terms of pathogenetic biological mechanism, differing from the pure depressive picture only in the phenomenology. This should be a "continuum" of phenomena of the same dysthymic spectrum, and the definition of endothymic anxiety or of anxious thymopathy (7), or endoreactive dysthymia (10) or, again, atypical depression (11) (to be differentiated from the dysthymic disorders and from the adaptation disorders of DSM-III), at least for the disorders of adult age, could stress the peculiarity of this kind of anxiety combined with depression, not in terms of pure occasional phenomenological overlapping, but of pathologically and biologically determined coincidence. In my own experience, anxiety and depression cannot be framed "tout court" in dualistic or dimensionalistic definitions. An important factor is the frequent coexistence in the aged patient of the two aspects in the so-called anxious-de­pressive syndrome. Now, I will try to point out the onset and time course of the symptoms anxiety and depression within this syndrome. In many cases, an anxious state is found initially, which is extremely more frequent than in the younger subject, without "crystallizations" of neurotic type (phobic, obsessive pictures, etc.). It can remain as such or turn to a depressive state, whose severity could qualify in etiopatho-genetic terms, namely, the depressive state following an initial period of anxiety (which could be interpreted in the aged subject as a "trigger" experience) will be deeper the more biologically vulnerable the subject, or the more prone to severe depressive episodes. In some cases, depression seems to be more superficial, with anxiety, insomnia, and the presence of somatizations covering the greater part of the clinical picture with a preserved psychomotor activity. This form of depression can be more related to reactive or situational factors than to endog­enous, biologically determined ones. Only in this instance is it appropriate to talk of an "anxious-depressive state." On the contrary, in the depressive forms of late onset, depression could end up with a total replacement of the initial anxious phenomena. In the reactive forms, we observe the prevalence of excit­ability, restlessness, irritability, whereas in the endogenous forms the psychomotor inhibition is prevalent and suicidal tendencies are present, such as the depressive somatic core or biological symptoms (like circadian mood variations, loss of appetite, loss of weight, reduced libido, insomnia) peculiar to major depression in the adult. Therefore, the evolution of the initial anxiety is different, de­pending on the occurrence of dysthymic or adaptation disorders, or of endoge­nous features. In the former instances, anxiety leads to a reactive depressive state, in the latter, it can be viewed as a phenomenon of a biologically determined dysthymic spectrum, substantially overlapping the major depression of adult subjects. Concerning endogenicity or primarity of depression, it is clear that I am referring to the depressive states occurring in advanced age and not depressive states ap­pearing in elderly subjects suffering also in their adult life from a major affective disorder.

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