Psychopharmacologic treatment of anxiety in the medically ill elderly patient: special considerations

The use of psychotropic agents to treat anxiety in medically ill elderly patients requires consideration of special pharmacokinetic and pharmacodynamic factors in drug selection. In this review, the use of seven general classes of psychotropic drugs with anxiolytic activity will be considered for use in the medically ill: benzodiazepines, azapirones, cyclic (non-monoamine oxidase [MAO] inhibitor) antidepressants, beta-adrenergic blocking agents, antihistamines, neuroleptics, and MAO inhibitors. Attention will be given to developing rational strategies for drug selection in order to minimize deleterious side effects, to which medically ill elderly patients may be vulnerable.