Anxiety may need tweaked treatment for boomers

For Kathy Tench, a 64-year-old Philadelphia charter schoolteacher, anxiety is the voice that comes nattering in the middle of the night.

It might start with a stray thought after waking up to use the bathroom - "Why was I left out of that e-mail loop at work?" - and ramp up to a spiral of worry: Maybe they don't value my input. Maybe I'll be pink-slipped in the next round of budget cuts. Then how will I pay the mortgage? What if I can't retire at 70, as I plan?

She sometimes lies there, obsessing, until dawn. And she's not alone. Anxiety disorders - which include generalized anxiety of the type that plagues Tench, as well as panic attacks, phobias, and posttraumatic stress - are the most common mental-health problem among older adults, affecting about one in 10 people over age 55.

"People say, 'Oh, sure, everybody's anxious,' " says Julie Wetherell, professor of psychology at the University of California-San Diego and coauthor of a 2011 article, "A Lifespan View of Anxiety Disorders." "What people don't recognize is that anxiety tends to be a very chronic condition that often arises early in life and doesn't remit."

Baby boomers, currently in the midlife "crunch" years of 50 to 65, may be especially vulnerable. They're no longer as robust as they were at 30 or 40, but their responsibilities and concerns continue to mount: They worry about aging parents, children fleeing the nest (or, these days, coming home to live in the basement), retirement, finances, and their own physical health.

"Things start to change" when people enter their 50s, says Tamar E. Chansky, a Philadelphia psychologist and author of Freeing Yourself from Anxiety. "We're not able to lift and move things without hurting our backs. . . . Our children may be going to college or having their own children. There's the 'How did I get here?' feeling. All those things could be triggers for anxiety."

What's more, Chansky says, the uncertainty of aging may come as a particular jolt to the boomer generation. "For this cohort, in a lot of ways, the world opened up. They set the cultural trends; they started the businesses. It's new for them to not feel invincible."

Tench had always thought of herself as competent and flexible. But her world began to unravel a few years ago: a restaurant, co-owned with her partner, floundered, taking most of Tench's inheritance with it. Then the relationship itself tanked; her partner of 22 years moved out, leaving Tench alone with her house, her garden, and her cats.

"I obsess about retirement. I obsess about money. I can feel my heart racing. But mostly, it's my brain. I just want to say, 'Stop!' " When her mind is spinning, Tench avoids driving, lest she be too preoccupied at the wheel. And she worries that continued anxiety could affect both her professional life and her health.

Anxiety specialists say those are valid concerns, especially as researchers learn more about the effects of chronic anxiety on the body and brain. Persistent worrying can trigger or exacerbate headaches, gastrointestinal distress, and chest pain. And neuropsychologists are learning more about what happens to a brain and nervous system bathed in a continuous tide of cortisol, the stress chemical released when anxiety peaks.

High levels of cortisol can impair memory and concentration, says Wetherell. Unremitting, long-term anxiety may even compromise the immune system and accelerate aging. The interesting question, Wetherell says, is "can we reverse the process? If we treat the anxiety, will that reverse [patients'] cognitive function and improve their health?"

So far, little research has focused on the long-term treatment of anxiety in older adults. But as the boomer population - an estimated 77 million people - enters the "middle age of anxiety," they will likely draw attention, and research dollars, to the issue.

In the meantime, doctors say, anxiety remains a highly treatable mental disorder. But the treatments that work well with younger adults may need to be tweaked for an aging population, says Eric Lenze, a professor of psychiatry at Washington University in St. Louis and coauthor of the article on anxiety across the life span.

Two classes of medication are commonly used to treat anxiety - benzodiazepines (Valium, Xanax) and SSRIs (Prozac, Zoloft). The former, which offer a "quick fix" for anxiety symptoms, can also cause memory problems and impair reaction time, making them a poor choice for older adults, Lenze says.

The second group of medicines, especially when combined with cognitive behavior therapy that teaches patients to examine their unrealistic fears and interrupt the cycle of worry, may be a better option, he says.

Chansky, the Philadelphia psychologist, tries to help anxious patients remember past challenges they have met successfully. Reid Wilson, director of the Anxiety Disorders Treatment Center in Chapel Hill and author of Don't Panic: Taking Control of Anxiety Attacks, advises patients to decide whether their worries are a "signal," indicating a problem that requires a plan, or just "noise." He teaches them to manage the "noise" - for instance, by "putting the worry on a leaf and floating it down a river in your mind, or postponing it to when you can address it."

Anxiety experts say that vulnerability to worry is partly a matter of genetics - some people are high-strung and anxious from birth - and partly a matter of circumstances and attitude.

"Sometimes in this [boomer] age group, particularly, anxiety can be fueled if you have a sense of over-responsibility. If you think you have to be everything to everybody - your children, your aging parents, your job, your life-partner - that can make you anxious," says Judith Beck, president of the Beck Institute for Cognitive Behavior Therapy in Bala Cynwyd.

Beck and others say that older adults can cultivate a mind-set that may thwart anxiety. "When people feel effective, that's a very strong protective factor," she says. A strong social network helps; so does having meaningful work and a sense of purpose. And relaxation techniques - whether learned from a book, a class or a therapist - can help calm habits of worry and break the pattern of anxiety.

"These disorders are highly treatable," says Lenze. "There's no reason someone in 2012 ought to be at home living with this problem."

Yet that's just what Marilyn Hazelton has been doing nearly all her life. The 67-year-old Allentown poet and teacher recalls feeling anxious, shy, and easily shamed from the time she was in elementary school. As an adult, her anxiety continued through a troubled first marriage, a more compatible second marriage, and then the death of her son 10 years ago after a long struggle with mental illness.

Hazelton took Zoloft for a short time, but didn't like the way it made her feel. Anxiety became a roadblock in her professional and personal life. "It was like having another layer on top of myself that was inhibiting movement and thinking." She was afraid to send query letters to editors who might publish her poetry; she avoided introducing herself to the principal when she worked as a visiting writer in schools.

But recently, Hazelton has been trying to "interrupt [the anxiety] and reframe." She'll tell herself, when a spiral of worry begins, "I don't want to do this. This is taking my time and my life." Instead, she will work on a poem, visit the art museum to see a favorite painting, or simply notice something beautiful - the wisteria, the just-bloomed fringe trees - in the garden.

"I'm trying to work more with gratitude. I'm working to not catastrophize. I would say my anxiety is manageable. I've got some tools."