Why Is Panic Disorder Less Frequent in Late life?

Epidemiological studies have found that few cases of panic disorder arise for the first time after the age of 40 years, and there is a steady decline in the prevalence of existing cases in the latter half of life. The authors review these epidemiological findings and explore various hypotheses that might explain the decreased frequency of panic disorder in old age. There is no available evidence to suggest that methodological factors have led to an underestimation of the prevalence of this disorder in older rather than younger age groups. However, there is evidence that disorder-associated mortality and age-related changes in brain neurochemistry may contribute to the decreased frequency of this illness in later life. A cohort effect also should be considered, although currently there are no data available to support or refute this idea.