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Optimizing Pharmacotherapy in Older Patients with Depression or Anxiety

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Optimizing Pharmacotherapy in Older Patients

Part of the book series: Practical Issues in Geriatrics ((PIG))

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Abstract

Depression and anxiety are common disorders in old age and frequently coexist. Depression is under recognized and undertreated although curable. Antidepressants are the first line for depression treatment. They are efficacious in old patients and may be associated to non-pharmacological treatment (psychotherapy, cognitive behavioural therapy, electroconvulsive therapy) according to the clinical presentation. To optimize antidepressant efficiency, an individualized approach for antidepressant choice, dose and duration of treatment is necessary. A regular follow-up improves adherence to treatment. Mood stabilizers are also effective in unipolar or bipolar disorders with a careful monitoring of side effects

Antidepressant efficiency is more controversial for depressed patients with cognitive impairment although often prescribed.

Benzodiazepines are commonly prescribed for anxiety or sleep disorders. They are efficacious for anxiety attacks. Yet they are overused despite their numerous side effects, with many chronic users (more than 3 consecutive months) and misused with long-lasting benzodiazepines prescription instead of short-lasting benzodiazepines. To optimize benzodiazepines’ prescription, withdrawal should be included from the first prescription. For chronic users, guidelines recommend a gradual discontinuation during a dedicated consultation. Non-pharmacological treatment is effective for moderate anxiety.

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Bonin-Guillaume, S. (2023). Optimizing Pharmacotherapy in Older Patients with Depression or Anxiety. In: Cherubini, A., Mangoni, A.A., O’Mahony, D., Petrovic, M. (eds) Optimizing Pharmacotherapy in Older Patients. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-031-28061-0_25

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