Beyond Depression

Sometimes James Coats would wake his family in the darkness of a quiet night because he was sure he was about to die. His chest hurt, he felt dizzy, and he had an overwhelming sense of doom.

"I'd haul my wife and children off to the emergency room at two or threein the morning, because I thought I was having a heart attack," says Coats,56, a semi-retired construction contractor who lives near Raleigh, N.C. "I'dfind out it wasn't a heart attack, but it sure felt like one."

Coats had other unexplained symptoms. His heart rate and respiration would suddenly increase. He would begin to perspire excessively, and tremble. But most of the time he would be filled with a pervasive anxiety that left him incapable of doing such simple things as leaving the house.

It took nine years for Coats to find out that he has an anxiety disorder, and only after the proper diagnosis did he get the help he needed.

The Other Mental Health Problem

While depression in older adults is the mental health problem most often discussed, it is not the most common one faced by older adults -- a fact publicized in a new government report, Mental Health: A Report of the Surgeon General, released in December 1999.

Anxiety disorders, like the kind experienced by Coats, are the most common form of mental illness among adults, including those age 55 and older, according to the report. These conditions -- such as panic attacks, phobias, and obsessive-compulsive disorder -- are "important but understudied conditions in older adults," according to the report.

People age 55 and older are more than twice as likely to suffer from anxiety as depression. According to estimates in the report, during any one year, about 11.4 % of adults age 55 and older have anxiety, compared to 4.4% who have a mood disorder such as depression.

The 458-page report ?- the first-ever on mental illness from the U.S.Surgeon General -? incorporates reams of recent research from all agegroups. Like past reports on such health issues as smoking, this one tries toenlighten the public about a health problem so they can "confront theattitudes, fear, and misunderstanding that remain as barriers [to treatment] before us," Surgeon General David Satcher, M.D., Ph.D., writes in the preface.

R. Reid Wilson, Ph.D., who treated James Coats, is a psychologist at the University of North Carolina, Chapel Hill, and also has a private practice. "Anxiety disorders in the older population appear to be an unrecognizedand unaddressed problem," he says.

Defining the Problem

The umbrella term "anxiety disorder" is used to describe a range of mental health problems, including:

• Phobias, such as fear of flying, heights, or public places
• Panic disorder, or the sudden feeling of impending doom
• Obsessive-compulsive disorder, in which people experiencesenseless or distressing thoughts that lead them to repeat actions, likehand washing multiple times in rapid succession
• Generalized anxiety disorder, often described as "a constantstate of worry"