From the Guidelines
The recommended medication for treating anxiety in elderly patients typically starts with a selective serotonin reuptake inhibitor (SSRI) such as sertraline (Zoloft) at a low initial dose of 25mg daily, which can be gradually increased if needed to 50-100mg daily. For elderly patients, the principle "start low, go slow" is essential due to their increased sensitivity to medications and higher risk of side effects 1.
Key Considerations
- Benzodiazepines like lorazepam (0.25-0.5mg once or twice daily) may be used for short-term management of acute anxiety symptoms, but should be avoided for long-term use due to risks of falls, cognitive impairment, and dependence 1.
- Non-pharmacological approaches should be incorporated alongside medication, including cognitive behavioral therapy, relaxation techniques, and regular physical activity.
- Treatment response should be monitored closely, with medication adjustments made gradually every 2-4 weeks as needed.
- These recommendations reflect the physiological changes in older adults, including decreased drug metabolism, altered drug distribution, and increased blood-brain barrier permeability, which affect how medications are processed in their bodies.
Medication Options
- SSRIs: sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro) are preferred due to their favorable adverse effect profiles 1.
- Benzodiazepines: lorazepam, alprazolam, but use with caution due to risks of dependence and cognitive impairment 1.
- Non-benzodiazepines: buspirone (BuSpar) may be used for mild to moderate anxiety, but may take 2-4 weeks to become effective 1.
Important Notes
- Always prioritize the patient's safety and well-being when prescribing medications, especially in elderly patients with multiple comorbidities.
- Regularly review and adjust the medication regimen to minimize adverse effects and optimize treatment outcomes.
From the FDA Drug Label
For elderly or debilitated patients, an initial dosage of 1 mg/day to 2 mg/day in divided doses is recommended, to be adjusted as needed and tolerated 10 mg/day is the recommended dose for elderly patients
- Recommended medication and dosage:
- Lorazepam: 1 mg/day to 2 mg/day in divided doses
- Escitalopram: 10 mg/day
- Key consideration: The dosage of these medications should be adjusted as needed and tolerated by the elderly patient, and it is essential to monitor for potential adverse effects 2, 3, 3
From the Research
Recommended Medication for Anxiety in Elderly Patients
The recommended medications for treating anxiety in elderly patients include:
Dosage Recommendations
The dosage recommendations for these medications are:
- Sertraline: 50-100 mg/day 4, with a starting dose of 50 mg/day and the option to increase in 50 mg/day increments up to a maximum of 200 mg/day 8
- Buspirone: 10-15 mg/day 4
Efficacy and Safety
Both sertraline and buspirone have been shown to be efficacious and well-tolerated in the treatment of generalized anxiety disorder (GAD) in elderly patients 4. Sertraline has also been found to be effective in the treatment of major depressive disorder in elderly patients 5, 6. Buspirone is considered a good option for prolonged therapy due to its lack of physical dependence, interaction with alcohol, and psychomotor impairment 7.
Considerations for Elderly Patients
When treating anxiety in elderly patients, it is important to consider the potential for drug interactions and the patient's overall health status. Sertraline has a low potential for drug interactions and does not require dosage adjustments based on age alone 5, 6, 8. Buspirone is also a good option due to its safety profile and lack of interaction with other medications 7.