Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-26T12:33:02.776Z Has data issue: false hasContentIssue false

Chapter 12 - Pharmacological Treatment of Anxiety in Later Life

Published online by Cambridge University Press:  08 March 2021

Gerard J. Byrne
Affiliation:
University of Queensland
Nancy A. Pachana
Affiliation:
University of Queensland
Get access

Summary

Although behavioural and psychological interventions are considered first-line treatments for anxiety disorders in older people (National Institute for Health and Care Excellence, 2014), psychotropic medications are also widely prescribed (Hollingworth & Siskind, 2010). Drugs from a range of psychotropic classes have been used to treat anxiety disorders, including benzodiazepines, antidepressants, anticonvulsants, and antipsychotics (Reinhold et al., 2011). While there is clinical trial evidence for the short-term efficacy of drugs from each of these classes, particularly for generalized anxiety disorder (GAD), there is scant evidence for long-term effectiveness. Psychotropic drugs exhibit a wide range of adverse effects, including some that pose particular hazards in later life.

Type
Chapter
Information
Anxiety in Older People
Clinical and Research Perspectives
, pp. 189 - 204
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alaka, K. J., Noble, W., Montejo, A., et al. (2014). Efficacy and safety of duloxetine in the treatment of older adult patients with generalized anxiety disorder: a randomized, double-blind, placebo-controlled trial. International Journal of Geriatric Psychiatry, 29(9), 978986.CrossRefGoogle ScholarPubMed
Appelberg, B. G., Syvälahti, E. K., Koskinen, T. E., Mehtonen, O. P., Muhonen, T. T. and Naukkarinen, H. H. (2001). Patients with severe depression may benefit from buspirone augmentation of selective serotonin reuptake inhibitors: results from a placebo-controlled, randomized, double-blind, placebo wash-in study. Journal of Clinical Psychiatry, 62(6), 448452.CrossRefGoogle ScholarPubMed
Balsamo, M., Cataldi, F., Carlucci, L. and Fairfield, B. (2018). Assessment of anxiety in older adults: a review of self-report measures. Clinical Interventions in Aging, 13, 573593.CrossRefGoogle ScholarPubMed
Barbui, C., Esposito, E. and Cipriani, A. (2009). Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. Canadian Medical Association Journal, 180(3), 291297.Google Scholar
Böhm, C., Robinson, D. S., Gammans, R. E., et al. (1990). Buspirone therapy in anxious elderly patients: a controlled clinical trial. Journal of Clinical Psychopharmacology, 10(Suppl. 3), 47S51S.CrossRefGoogle ScholarPubMed
Brawman-Mintzer, O., Knapp, R. G., Rynn, M., Carter, R. E. and Rickels, K. (2006). Sertraline treatment for generalized anxiety disorder: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry, 67(6), 874881.Google Scholar
Bresolin, N., Monza, G., Scarpini, E., et al. (1988). Treatment of anxiety with ketazolam in elderly patients. Clinical Therapeutics, 10(5), 536542.Google Scholar
Cohn, J. B. (1984). Double-blind safety and efficacy comparison of alprazolam and placebo in the treatment of anxiety in geriatric-patients. Current Therapeutic Research: Clinical and Experimental, 35(1), 100112.Google Scholar
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T. and Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry, 13(1), 5667.CrossRefGoogle ScholarPubMed
DeMartinis, N., Rynn, M., Rickels, K. and Mandos, L. (2000). Prior benzodiazepine use and buspirone response in the treatment of generalized anxiety disorder. Journal of Clinical Psychiatry, 61(2), 9194.Google Scholar
Eriksson, H., Mezhebovsky, I., Magi, K., She, F. and Datto, C. (2008). Double-blind, randomised study of extended release quetiapine fumarate (quetiapine XR) monotherapy in elderly patients with generalized anxiety disorder (GAD). International Journal of Psychiatry in Clinical Practice, 12(4), 332333.Google Scholar
Fawcett, J. and Barkin, R. L. (1998). A meta-analysis of eight randomized, double-blind, controlled clinical trials of mirtazapine for the treatment of patients with major depression and symptoms of anxiety. Journal of Clinical Psychiatry, 59(3), 123127.Google Scholar
Feltner, D. E., Liu-Dumaw, M., Schweizer, E. and Bielski, R. (2011). Efficacy of pregabalin in generalized social anxiety disorder: results of a double-blind, placebo-controlled, fixed-dose study. International Clinical Psychopharmacology, 26(4), 213220.Google Scholar
Frattola, L., Piolti, R., Bassi, S., et al. (1992). Effects of alpidem in anxious elderly outpatient: a double-blind, placebo-controlled trial. Clinical Neuropharmacology, 15(6), 477487.Google Scholar
Generoso, M. B., Trevizol, A. P., Kasper, S., Cho, H. J., Cordeiro, Q. and Shiozawa, P. (2017). Pregabaling for generalized anxiety disorder: an updated systematic review and meta-analysis. International Clinical Psychopharmacology, 32(1), 4955.Google Scholar
Gonçalves, D. A. and Byrne, G. J. (2012). Interventions for generalized anxiety disorder in older adults: systematic review and meta-analysis. Journal of Anxiety Disorders, 26, 111.Google Scholar
Gould, C. E., Segal, D. L., Yochim, B. P., Pachana, N. A., Byrne, G. J. and Beaudreau, S. A. (2014). Measuring anxiety in late life: a psychometric examination of the geriatric anxiety inventory and geriatric anxiety scale. Journal of Anxiety Disorders, 28(8), 804811.Google Scholar
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 5055.Google Scholar
Hendriks, G. J., Keijsers, G. P., Kampman, M., et al. (2010). A randomized controlled study of paroxetine and cognitive–behavioural therapy for late-life panic disorder. Acta Psychiatrica Scandinavica, 122(1), 1119.Google Scholar
Hertzberg, M. A., Butterfield, M. I., Feldman, M. E., et al. (1999). A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder. Biological Psychiatry, 45(9), 12261229.Google Scholar
Hollingworth, S. A. and Siskind, D. J. (2010). Anxiolytic, hypnotic and sedative medication use in Australia. Pharmacoepidemiology and Drug Safety, 19(3), 280288.Google Scholar
Hollingworth, S. A., Siskind, D. J., Nissen, L. M., Robinson, M. and Hall, W. D. (2010). Patterns of antipsychotic medication use in Australia 2002–2007. Australian and New Zealand Journal of Psychiatry, 44(4), 372377.CrossRefGoogle ScholarPubMed
Katz, I. R., Reynolds, C. F., Alexopoulos, G. S. and Hackett, D. (2002). Venlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials. Journal of the American Geriatrics Society, 50(1), 1825.Google Scholar
Kimura, M., Tateno, A. and Robinson, R. G. (2003). Treatment of post-stroke generalized anxiety disorder comorbid with poststroke depression: merged analysis of nortriptyline trials. American Journal of Geriatric Psychiatry, 11(3), 320327.CrossRefGoogle Scholar
Koepke, H. H., Gold, R. K., Linden, M. E., Lion, J. R. and Kickels, K. (1982). Multicenter controlled study of oxazepam in anxious elderly outpatients. Psychosomatics, 23(6), 641645.Google Scholar
Kruszewski, S. P. (2005). Conclusions inconsistent with results with citalopram. American Journal of Psychiatry, 162(11), 21952196.Google Scholar
Lader, M. and Scotto, J. C. (1998). A multicentre double-blind comparison of hydrozyzine, buspirone and placebo in patients with generalized anxiety disorder. Psychopharmacology (Berlin), 54 (Suppl.), 6468.Google Scholar
Landreville, P., Landry, J., Baillargeon, L., Guerette, A. and Matteau, E. (2001). Older adults’ acceptance of psychological and pharmacological treatments for depression. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56(5), P285P291.CrossRefGoogle ScholarPubMed
Lenze, E. J., Mulsant, B. H., Shear, M. K., et al. (2005). Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. American Journal of Psychiatry, 162(1), 146150.CrossRefGoogle ScholarPubMed
Lenze, E. J., Rollman, B. L., Shear, M. K., et al. (2009). Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. Journal of the American Medical Association, 301(3), 295303.Google Scholar
Majercsik, E. and Haller, J. (2004). Interactions between anxiety, social support, health status and buspirone efficacy in elderly patients. Progress in Neuropsychopharmacology and Biological Psychiatry, 28, 11611169.Google Scholar
McIntyre, E., Saliba, A. J., Wiener, K. K. and Sarris, J. (2016). Herbal medicine use behaviour in Australian adults who experience anxiety: a descriptive study. BMC Complementary and Alternative Medicine, 16, 60.CrossRefGoogle ScholarPubMed
Mezhebovsky, I., Magi, K., She, F., Datto, C. and Eriksson, H. (2013). Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. International Journal of Geriatric Psychiatry, 28(6), 615625.CrossRefGoogle ScholarPubMed
Mokhber, N., Azarpazhooh, M. R., Khajehdaluee, M., Velayati, A. and Hopwood, M. (2010). Randomized, single-blind trial of sertraline and buspirone for treatment of elderly patients with generalized anxiety disorder. Psychiatry and Clinical Neuroscience, 64(2), 128133.Google Scholar
Montgomery, S., Chatamra, K., Pauer, L., Whalen, E. and Baldinetti, F. (2008). Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. British Journal of Psychiatry, 193(5), 389394.Google Scholar
Mula, M., Pini, S. and Cassano, G. B. (2007). The role of anticonvulsant drugs in anxiety disorders: a critical review of the evidence. Journal of Clinical Psychopharmacology, 27(3), 263372.Google Scholar
National Institute for Health and Care Excellence (2014). Anxiety Disorders, Quality Standard QS53, February 2014, NICE, UK. www.nice.org.uk/guidance/qs53/chapter/About-this-quality-standard (accessed 7 May 2018).Google Scholar
Pande, A. C., Davidson, J. R., Jefferson, J. W., et al. (1999). Treatment of social phobia with gabapentin: a placebo-controlled study. Journal of Clinical Psychopharmacology, 19(4), 341348.CrossRefGoogle ScholarPubMed
Reinhold, J. A., Mandos, L. A., Rickels, K. and Lohoff, F. W. (2011). Pharmacological treatment of generalized anxiety disorder. Expert Opinion on Pharmacotherapy, 12(16), 24572467.Google Scholar
Sarris, J. (2018). Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytotherapy Research, 32(7), 11471162.Google Scholar
Savage, K., Firth, J., Stough, C. and Sarris, J. (2018). GABA-modulating phytomedicines for anxiety: A systematic review of preclinical and clinical evidence. Phytotherapy Research, 32(1), 318.Google Scholar
Schuurmans, J., Comijs, H., Emmelkamp, P. M., et al. (2006). A randomized, controlled trial of the effectiveness of cognitive–behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults. American Journal of Geriatric Psychiatry, 14(3), 255263.Google Scholar
Steenen, S. A., van Wijk, A. J., van der Heijden, G. J. M. G., van Westrhenen, R., de Lange, J. and de Jongh, A. (2016). Propranolol for the treatment of anxiety disorders: systematic review and meta-analysis. Journal of Psychopharmacology, 30(2), 128139.Google Scholar
Wetherell, J. L., Petkus, A. J., White, K. S., et al. (2013). Antidepressant augmented with cognitive–behavioral therapy for generalized anxiety disorder in older adults. American Journal of Psychiatry, 170(7), 782789.Google Scholar
Woodward, R. and Pachana, N. A. (2009). Attitudes towards psychological treatment among older Australians. Australian Psychologist, 44(2), 8693.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×