Anxiety in the elderly: treatment strategies

Anxiety in the elderly is often mixed with depression, and successful antidepressant treatment will often also eliminate the anxiety. For specific symptoms of generalized anxiety, benzodiazepines are important therapeutic agents. Selection of an appropriate benzodiazepine is guided by pharmacokinetic properties of individual drugs. Long half-life benzodiazepines usually are not preferred for older patients because of cumulative toxicity. Among the short half-life drugs, high-potency compounds (e.g., lorazepam, alprazolam) may be more toxic than low-potency compounds (e.g., oxazepam). Although confirming controlled data are lacking, clinical experience suggests that dependence, rebound symptoms, and memory impairment may be more intense with lorazepam and alprazolam. Clinicians should endeavor to use benzodiazepines for short periods when treating the elderly. Long-term use has been reported effective and nonhazardous, but subtle and gradual cognitive impairment may occur in other patients over time. Buspirone has also been reported as an effective, nontoxic antianxiety compound for older patients, but more experience and comparative research data are needed.