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Pharmacological Management of Anxiety Disorders in the Elderly

  • Geriatric Disorders (D Steffens and K Zdanys, Section Editors)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Opinion statement

Anxiety disorders are common in the elderly. Additionally, anxiety symptoms often accompany comorbid psychiatric, medical, as well as neurodegenerative diseases in the older population. Anxiety in the elderly, often accompanied by depression, can lead to worsening physical, cognitive, and functional impairments in this vulnerable population. Antidepressants are considered first-line treatment. Both selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are efficacious and well-tolerated in the elderly. Some SSRIs are strong inhibitors of the cytochrome P450 hepatic pathway whereas others have less potential for drug interaction. Those antidepressants with more favorable pharmacokinetic profiles should be considered first-line in the treatment of anxiety. Mirtazapine and vortioxetine are also considered safe treatment options. Buspirone may have a benefit, but lacks studies in elderly populations. Although tricyclic/tetracyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may be effective in the elderly, their side effect and safety profiles are suboptimal and thus are not recommended in late-life. Benzodiazepines and beta-blockers should generally be avoided when treating anxiety in the elderly. There is not enough evidence to support the use of antipsychotics or mood stabilizers given their risk of problems in both the long- and short-term. In addition, antipsychotics have a black box warning for increased mortality in elderly patients with dementia.

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  1. Center on Aging, Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1695 NW 9th Avenue, Suite 3204A (D101), Miami, FL, 33136, USA

    Elizabeth A. Crocco MD, Sindy Jaramillo MD, Caroline Cruz-Ortiz MD & Katherine Camfield BS

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Correspondence to Elizabeth A. Crocco MD.

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Katherine Camfield, Caroline Cruz-Ortiz, and Sindy Jaramillo declare that they have no conflict of interest.

Elizabeth Crocco reports grants from Otsuka Pharmaceutical Development & Commercialization, Inc; grants from Avanir Pharmaceuticals; personal fees from Mantovani Foundation, Milan, Italy; personal fees from Primed; and personal fees from Baptist Health, outside the submitted work.

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Crocco, E.A., Jaramillo, S., Cruz-Ortiz, C. et al. Pharmacological Management of Anxiety Disorders in the Elderly. Curr Treat Options Psych 4, 33–46 (2017). https://doi.org/10.1007/s40501-017-0102-4

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