Interactions between anxiety, social support, health status and buspirone efficacy in elderly patients

Psychosocial factors are among the etiological factors of anxiety, and have been shown to affect the anxiolytic efficacy of buspirone in laboratory rodents. Disparate human studies suggest that a similar interaction may be valid for anxious patients. However, this interaction is poorly known at present. It was hypothesized that social support and health status are especially relevant psychosocial problems in elderly, and as such, have a large impact on both anxiety and the efficacy of anxiolytic treatment with buspirone. The hypothesis was assessed by three independent studies performed in a total number of 384 elderly in-patients (109 males, 275 females, age similar to80 years). A low number of social contacts associated with a large number of diseases proved to be a strong risk factor for anxiety, whereas the reverse condition (many contacts/few diseases) was associated with considerably lower Hamilton Rating Scale for Anxiety (HAM-A) scores. Buspirone ameliorated anxiety significantly in general, but the "many contacts/many diseases" condition was associated with twice as much improvement as the "few contacts/few diseases" condition. The patient's self-evaluation of health status was predicted strongly by the disease score used in the above two studies. Taken conjointly, data suggest that the major Axis-IV problems faced by the age class studied (social support and health status) have a strong effect on both anxiety and buspirone responsiveness in elderly patients. Thus, drug responses appear to be modulated by nonpharmacological factors, and research directed towards identifying such factors would provide information important to a more appropriate patient targeting of certain medications. (C) 2004 Elsevier Inc. All rights reserved.