Anxiety and its treatment in the elderly

A search for references relating to the treatment of anxiety disorders in the elderly was made using the BIDS computerized database back to 1981, the Medline computerized database back to 1983, and the PsycLIT computerized database back to 1974, together with a search of relevant citations. The profusion of clinical recommendations was found to contrast with the lack of adequate supporting controlled clinical trials. There was evidence of a trend away from the benzodiazepine class of anxiolytics and an upsurge in interest in agents active at the serotonin receptor, although with the possible exception of buspirone, there is so far little research evidence for advocating use of the new agents in the elderly. Psychological therapies may be useful for many types of anxiety in the elderly, but their efficacy is also as yet unproven. Rational prescribing recommendations for anxiety in this age group will require controlled clinical trials incorporating a multiaxial approach to anxiety assessment, quality-of-life measures, psychological and placebo controls, and adequate follow-up intervals.