Skip to main content

Optimal Management of Anxiety in Older Patients

Drugs & Aging volume 9, pages 191–201 (1996)Cite this article

Summary

Although the incidence of anxiety disorders diminishes with age, the prevalence of anxiety symptoms among older patients is substantial. These symptoms, which include cognitive and somatic manifestations, are a source of diminished quality of life. The many potential sources of illness- and medication-induced anxiety must be excluded before instituting treatment. The general principles of antianxiety medication treatment in older patients include: (i) symptom relief with minimum sedation; (ii) improvement in sleep; (iii) freedom from autonomic and cognitive toxicities; and (iv) freedom from physical dependence and drug interactions. Older compounds such as the tricyclic antidepressants should be avoided, since more modern agents (e.g. benzodiazepines and buspirone) are well tolerated and effective. Modern antidepressants have also been used to reduce anxiety symptoms, although there is a potential for the opposite effect to occur. The selective serotonin reuptake inhibitors appear to be better suited to treating syndromes such as panic and obsessive-compulsive disorder, whereas nefazodone would be a better choice for generalised anxiety complicated by depression.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

49,54 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Leon AC, Portera L, Weissman MM. The social costs of anxiety disorders. Br J Psychiatry Suppl 1995 Apr; 27: 19–22

    PubMed  Google Scholar 

  2. Blazer DG, George L, Hughes D. The epidemiology of anxiety disorders: an age comparison. In: Salzman C, Lebowitz B, editors. Anxiety disorders in the elderly. New York: Springer, 1991: 17–30

    Google Scholar 

  3. Flint AJ. Epidemiology and comorbidity of anxiety disorders in the elderly. Am J Psychiatry 1994 May; 151: 640–9

    PubMed  CAS  Google Scholar 

  4. Cloninger CR. Comorbidity of anxiety and depression. J Clin Psychopharmacol 1990 Jan; 10: 43–6

    Article  Google Scholar 

  5. Fogelson D, Bystritsky A, Sussman N. Inter-relationships between major depression and anxiety disorders. Psychiatr Ann 1988 Mar; 18: 158–67

    Google Scholar 

  6. Stein MB, Kirk P, Prabhu V, et al. Mixed anxiety-depression in a primary-care clinic. J Affect Disord 1995 May 17; 34(2): 79–84

    PubMed  Article  CAS  Google Scholar 

  7. Lish JD, Zimmerman M, Farber NJ, et al. Psychiatric screening in geriatric primary care: should it be for depression alone? J Geriatr Psychiatry Neurol 1995 Jul; 8(3): 141–53

    PubMed  CAS  Google Scholar 

  8. WHO. International statistical classification of diseases and related health problems. 10th rev. ed. (ICD-10). Geneva: WHO, 1992

  9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. (DSM-IV). Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  10. Smith SL, Sherrill KA, Colenda CC. Assessing and treating anxiety in elderly persons. Psychiatr Serv 1995 Jan; 46(1): 36–42

    PubMed  CAS  Google Scholar 

  11. Smith SL, Colenda CC, Espeland MA. Factors determining the level of anxiety state in geriatric primary care patients in a community dwelling. Psychosomatics 1994 Jan–Feb; 35(1): 50–8

    PubMed  Article  CAS  Google Scholar 

  12. Weiss KJ. Management of anxiety and depression syndromes in the elderly. J Clin Psychiatry 1994 Feb; 55Suppl. 2: 5–12

    PubMed  Google Scholar 

  13. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32: 50–5

    PubMed  Article  CAS  Google Scholar 

  14. Rankin EJ, Gfeller JD, Gilner FH. Measuring anxiety states in the elderly using the State-Trait Anxiety Inventory for Children. J Psychiatr Res 1993 Jan–Mar; 27(1): 111–7

    PubMed  Article  CAS  Google Scholar 

  15. Parkerson GR, Broadhead WE, Tse CK. Anxiety and depressive symptom identification using the Duke Health Profile. J Clin Epidemiol 1996 Jan; 49(1): 85–93

    PubMed  Article  CAS  Google Scholar 

  16. Tueth MJ. Anxiety in the older patient: differential diagnosis and treatment. Geriatrics 1993 Feb; 48(2): 51–4

    PubMed  CAS  Google Scholar 

  17. Wise MG, Griffies WS. A combined treatment approach to anxiety in the medically ill. Louisiana State University School of Medicine, New Orleans. J Clin Psychiatry 1995; 56Suppl. 2: 14–9

    PubMed  Google Scholar 

  18. Bercsi SJ, Brickner PW, Saha DC. Alcohol use and abuse in the frail, homebound elderly: a clinical analysis of 103 persons. Drug Alcohol Depend 1993 Sep; 33(2): 139–49

    PubMed  Article  CAS  Google Scholar 

  19. Egbert AM. The older alcoholic: recognizing the subtle clinical clues. Geriatrics 1993 Jul; 48(7): 63–6, 69

    PubMed  CAS  Google Scholar 

  20. Whelan G. Alcohol-related health problems in the elderly. Med J Aust 1995 Mar 20; 162(6): 325–7

    PubMed  CAS  Google Scholar 

  21. Serfaty M, Masterton G. Fatal poisonings attributed to benzodiazepines in Britain during the 1980s [see comments]. Br J Psychiatry 1993 Sep; 163: 386–93

    PubMed  Article  CAS  Google Scholar 

  22. Conwell Y. Suicide among elderly persons. Psychiatr Serv 1995 Jun; 46: 563–4

    PubMed  CAS  Google Scholar 

  23. Massion AO, Warshaw MG, Keller MB. Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Am J Psychiatry 1993 Apr; 150(4): 600–7

    PubMed  CAS  Google Scholar 

  24. Warshaw MG, Fierman E, Pratt L, et al. Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD. Am J Psychiatry 1993 Oct; 150(10): 1512–6

    PubMed  CAS  Google Scholar 

  25. McLeod JD. Anxiety disorders and marital quality. J Abnorm Psychol 1994 Nov; 103(4): 767–76

    PubMed  Article  CAS  Google Scholar 

  26. Hocking LB, Koenig HG. Anxiety in medically ill older patients: a review and update. Int J Psychiatry Med 1995; 25(3): 221–38

    PubMed  Article  CAS  Google Scholar 

  27. Paul SM. Anxiety and depression: a common neurobiological substrate? J Clin Psychiatry 1988 Oct; 49 Suppl.: 13–6

    PubMed  Google Scholar 

  28. Reiman EM. The quest to establish the neural substrates of anxiety. Psychiatr Clin North Am 1988 Jun; 11: 295–307

    PubMed  CAS  Google Scholar 

  29. Teicher MH. Biology of anxiety. Med Clin North Am 1988 Jul; 72: 791–814

    PubMed  CAS  Google Scholar 

  30. Baldwin D, Rudge S. The role of serotonin in depression and anxiety. Int Clin Psychopharmacol 1995 Jan; 9Suppl. 4: 41–5

    PubMed  Article  Google Scholar 

  31. Martin LM, Fleming KC, Evans JM. Recognition and management of anxiety and depression in elderly patients. Mayo Clin Proc 1995 Oct; 70(10): 999–1006

    PubMed  Article  CAS  Google Scholar 

  32. Steinberg JR. Anxiety in elderly patients: a comparison of azapirones and benzodiazepines. Drugs Aging 1994 Nov; 5(5): 335–45

    PubMed  Article  CAS  Google Scholar 

  33. Hoehn-Saric R, Borkovec TD, Nemiah JC. Generalized anxiety. In: American Psychiatric Association. Treatment of psychiatric disorders. 2nd ed. Washington, DC: American Psychiatric Press, 1995

    Google Scholar 

  34. Boulenger JP, Lavallee YJ. Mixed anxiety and depression: diagnostic issues. J Clin Psychiatry 1993 Jan; 54 Suppl.: 3–8

    PubMed  Google Scholar 

  35. Shorr RI, Robin DW. Rational use of benzodiazepines in the elderly. Drugs Aging 1994 Jan; 4(1): 9–20

    PubMed  Article  CAS  Google Scholar 

  36. Cadieux RJ. Geriatric psychopharmacology: a primary care challenge. Postgrad Med 1993 Mar; 93(4): 281–2, 285–8, 294–301

    PubMed  CAS  Google Scholar 

  37. Fernandez F, Levy JK, Lachar BL, et al. The management of depression and anxiety in the elderly. J Clin Psychiatry 1995 Feb; 56Suppl. 2: 20–9

    PubMed  Google Scholar 

  38. Wise MG, Rieck SO. Diagnostic considerations and treatment approaches to underlying anxiety in the medically ill. J Clin Psychiatry 1993 May; 54 Suppl.: 22–6

    PubMed  Google Scholar 

  39. Simington JA, Laing GP. Effects of therapeutic touch on anxiety in the institutionalized elderly. Clin Nurs Res 1993 Nov; 2(4): 438–50

    PubMed  Article  CAS  Google Scholar 

  40. Rankin EJ, Gilner FH, Gfeller JD, et al. Efficacy of progressive muscle relaxation for reducing state anxiety among elderly adults on memory tasks. Percept Mot Skills 1993 Dec; 77 (3 Pt 2): 1395–402

    PubMed  Article  CAS  Google Scholar 

  41. Hanser SB, Thompson LW. Effects of a music therapy strategy on depressed older adults. J Gerontol 1994 Nov; 49(6): P265–9

    PubMed  CAS  Google Scholar 

  42. Andersson G, Green M. Anxiety in elderly hearing impaired persons. Percept Mot Skills 1995 Oct; 81(2): 552–4

    PubMed  Article  CAS  Google Scholar 

  43. Salzman C. Practical considerations in the pharmacologic treatment of depression and anxiety in the elderly. J Clin Psychiatry 1990 Jan; 51 Suppl.: 40–3

    PubMed  Google Scholar 

  44. Salzman C. Medication compliance in the elderly. J Clin Psychiatry 1995 Jan; 56Suppl. 1: 18–22

    PubMed  Google Scholar 

  45. Murray MD, Birt JA, Manatunga AK, et al. Medication compliance in elderly outpatients using twice-daily dosing and unit-of-use packaging. Ann Pharmacother 1993 May; 27(5): 616–21

    PubMed  CAS  Google Scholar 

  46. Isaac LM, Tamblyn RM. Compliance and cognitive function: a methodological approach to measuring unintentional errors in medication compliance in the elderly. Gerontologist 1993 Dec; 33(6): 772–81

    PubMed  Article  CAS  Google Scholar 

  47. Salzman C. Clinical geriatric psychopharmacology. 2nd ed. Baltimore (MD): Williams & Wilkins, 1992

    Google Scholar 

  48. Boyer W. Serotonin uptake inhibitors are superior to imipramine and alprazolam in alleviating panic attacks: a meta-analysis. Int Clin Psychopharmacol 1995 Mar; 10(1): 45–9

    PubMed  Article  CAS  Google Scholar 

  49. Andrews N, File SE. Increased 5-HT release mediates the anxiogenic response during benzodiazepine withdrawal: a review of supporting neurochemical and behavioural evidence. Psychopharmacology (Berl) 1993; 112(1): 21–5

    Article  CAS  Google Scholar 

  50. Barrett JE, Vanover KE. 5-HT receptors as targets for the development of novel anxiolytic drugs: models, mechanisms and future directions. Psychopharmacology (Berl) 1993; 112(1): 1–12

    Article  CAS  Google Scholar 

  51. Rickeis K, Downing R, Schweizer E, et al. Antidepressants for the treatment of generalized anxiety disorder: a placebo-controlled comparison of imipramine, trazodone, and diazepam. Arch Gen Psychiatry 1993 Nov; 50(11): 884–95

    Article  Google Scholar 

  52. Stoudemire A, Moran MG. Psychopharmacologic treatment of anxiety in the medically ill elderly patient: special considerations. J Clin Psychiatry 1993 May; 54 Suppl.: 27–33

    PubMed  Google Scholar 

  53. Markovitz PJ. Treatment of anxiety in the elderly. J Clin Psychiatry 1993 May; 54 Suppl.: 64–8

    PubMed  Google Scholar 

  54. Sakauye K. Behavioral disturbances: pharmacologic therapies. Psychiatr Ann 1995 Jul; 25: 425–31

    Google Scholar 

  55. Naranjo CA, Herrmann N, Mittmann N, et al. Recent advances in geriatric psychopharmacology. Drugs Aging 1995 Sep; 7(3): 184–202

    PubMed  Article  CAS  Google Scholar 

  56. Ashton H. Guidelines for the rational use of benzodiazepines: when and what to use. Drugs 1994 Jul; 48(1): 25–40

    PubMed  Article  CAS  Google Scholar 

  57. Ray WA, Griffin MR, Schaffner W, et al. Psychotropic drug use and the risk of hip fracture. N Engl J Med 1987; 316: 363–9

    PubMed  Article  CAS  Google Scholar 

  58. Wysowski DK, Baum C, Ferguson WJ, et al. Sedative-hypnotic drugs and the risk of hip fracture. J Clin Epidemiol 1996 Jan; 49(1): 111–3

    PubMed  Article  CAS  Google Scholar 

  59. Herings RM, Stricker BH, de Boer A, et al. Benzodiazepines and the risk of falling leading to femur fractures: dosage more important than elimination half-life. Arch Intern Med 1995 Sep 11; 155(16): 1801–7

    PubMed  Article  CAS  Google Scholar 

  60. Buckley NA, Dawson AH, Whyte IM, et al. Relative toxicity of benzodiazepines in overdose. BMJ 1995 Jan 28; 310(6974): 219–21

    PubMed  Article  CAS  Google Scholar 

  61. Sussman N. The uses of buspirone in psychiatry. J Clin Psychiatry Monogr 1994 May; 12: 3–19

    Google Scholar 

  62. Goldberg RJ. The use of buspirone in geriatric patients. J Clin Psychiatry Monogr 1994 May; 12: 31–5

    Google Scholar 

  63. Rickeis K, Amsterdam J, Clary C, et al. Buspirone in major depression: a controlled study. J Clin Psychiatry 1991; 52: 34–8

    Google Scholar 

  64. Littman AB, Fava M, McKool K, et al. Buspirone therapy for Type A behavior, hostility, and perceived stress in cardiac patients. Psychother Psychosom 1993; 59(2): 107–10

    PubMed  Article  CAS  Google Scholar 

  65. Sakauye KM, Camp CJ, Ford PA. Effects of buspirone on agitation associated with dementia. Am J Geriatr Psychiatry 1993; 1: 82–4

    Article  Google Scholar 

  66. Hohagen F, Kappler C, Schramm E, et al. Prevalence of insomnia in elderly general practice attenders and the current treatment modalities. Acta Psychiatr Scand 1994 Aug; 90(2): 102–8

    PubMed  Article  CAS  Google Scholar 

  67. Nierenberg AA, Adler LA, Peselow E, et al. Trazodone for antidepressant-associated insomnia. Am J Psychiatry 1994 Jul; 151(7): 1069–72

    PubMed  CAS  Google Scholar 

  68. Oehrberg S, Christiansen PE, Behnke K, et al. Paroxetine in the treatment of panic disorder: a randomised, double-blind, placebo-controlled study. Br J Psychiatry 1995 Sep; 167(3): 374–9

    PubMed  Article  CAS  Google Scholar 

  69. Pecknold JC, Luthe L, Iny L, et al. Fluoxetine in panic disorder: pharmacologic and tritiated platelet imipramine and paroxetine binding study. J Psychiatry Neurosci 1995 May; 20(3): 193–8

    PubMed  CAS  Google Scholar 

  70. Schweizer E, Feighner J, Mandos LA, et al. Comparison of venlafaxine and imipramine in the acute treatment of major depression in outpatients. J Clin Psychiatry 1994; 55: 104–8

    PubMed  CAS  Google Scholar 

  71. Rudorfer MV, Potter WZ. Antidepressants: a comparative review of the clinical pharmacology and therapeutic use of the ‘newer’ versus the ‘older’ drugs. Drugs 1989; 37: 713–38

    PubMed  Article  CAS  Google Scholar 

  72. Fawcett J, Marcus RN, Anton SF, et al. Response of anxiety and agitation symptoms during nefazodone treatment of major depression. J Clin Psychiatry 1995 Jun; 56Suppl. 6: 37–42

    PubMed  Google Scholar 

  73. Preskorn SH, Janicak PG, Davis JM, et al. Advances in the pharmacotherapy of depressive disorders. Princip Pract Psychopharmacother 1995; 1: 1–24

    Google Scholar 

  74. Rickeis K, Schweizer E, Clary C, et al. Nefazodone and imipramine in major depression: a placebo-controlled trial. Br J Psychiatry 1994; 164: 802–5

    Article  Google Scholar 

  75. Fontaine R, Ontiveros A, Elie R, et al. A double-blind comparison of nefazodone, imipramine, and placebo in major depression. J Clin Psychiatry 1994; 55: 234–41

    PubMed  CAS  Google Scholar 

  76. Ware JC, Rose FV, McBrayer RH. The acute effects of nefazodone, trazodone and buspirone on sleep and sleep-related penile tumescence in normal subjects. Sleep 1994 Sep; 17(6): 544–50

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Delaware Valley Research Associates Inc., 133 Ivy Lane, King of Prussia, Pennsylvania, 19406-2101, USA

    Kenneth J. Weiss

Authors
  1. Kenneth J. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenneth J. Weiss.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Weiss, K.J. Optimal Management of Anxiety in Older Patients. Drugs & Aging 9, 191–201 (1996). https://doi.org/10.2165/00002512-199609030-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199609030-00005

Keywords

  • Anxiety Disorder
  • Anxiety Symptom
  • Venlafaxine
  • Panic Disorder
  • Clin Psychiatry