Some factors shown to increase anxiety include very high levels of social contact, dysfunctional patient-caregiver relationships, and high physical dependency. Other factors that can negatively impact anxiety in older adults include boredom, social isolation, and unmet physical needs for proper nutrition, warmth, and cleanliness, for example. Pharmacologic treatment options for those with panic disorder can include a short course of benzodiazepines and long-term SSRIs or SNRIs. Cognitive behavioral therapy has proven to be a particularly effective nonpharmacologic approach to treatment of anxiety and panic. As-needed medications for anxiety can be helpful in the initial weeks of treatment as the therapeutic effect of SSRIs and SNRIs is approached. Useful medications for as-needed treatment of anxiety include low-dose trazodone (25 or 50mg every 4-6 hours as needed). Other options might include gabapentin, mirtazapine, or low-dose propranolol.

It is not uncommon for a resident to try multiple medications to manage anxiety disorder before finding a tolerated and effective psychotropic. An SSRI or SNRI are usually the first-line agent for pharmacotherapy. Concern for anxiety is often brought up by caregivers when patients demonstrate disruptive behaviors related to anxiety such as yelling out, resisting care, becoming frightened with personal care, and repetitive behaviors such as pushing a call light many times a day, pacing, or restlessness. First-line agents in the treatment of anxiety disorders in long-term care include SSRIs and SNRIs. Second-line agents or supporting agents may incude buspirone, mirtazapine, propranolol, and trazodone. Avoid benzodiazepines and anticholinergics. Strategies to address difficult to manage anxiety include reconsidering the first-line agent for appropriate dose and duration, adding an augmenting agent, switching from an SSRI to and SNRI, and considering the possibility of low-grade psychosis and a potential contributing factor to anxiety.

Antidepressants, when used appropriately and in combination with an individualized psychosocial approach, can dramatically improve depressive symptoms and the quality of life of residents who have major depressive disorder. The selection of antidepressants needs to take into account the patient’s medical problems, as well as what side effects one wants or wants to avoid for a particular patient. There is no compelling evidence that one antidepressant works better than any other for the treatment of majpr depressive disorder in long-term care populations. Selective serotonin reuptake inhibitors (SSRIs) are probably the most commonly selected first-line medications for the treatment of major depressive disorders in long-term care residents. Serotonin-norepinephrine reuptake inhibitors) have also been associated with a potentially increased risk of bleeding, although the risk appears to be lower compared to SSRIs.

Classification of drug treatments for depression is described noting the ambiguities of current terminology and the move towards standardised nomenclature based on pharmacology and mode of action, such as that proposed by the Neuroscience-based Nomenclature group. Antidepressant drugs are described in terms of background, mechanism of action, pharmacokinetics, side effects, interactions, contraindications and toxicity in overdose. Groups include selective serotonin re-uptake inhibitors (SSRI), serotonin and noradrenaline re-uptake inhibitors (SNRI), tricyclics, noradrenergic and specific serotoninergic antidepressants (NaSSA), monoamine oxidase inhibitors (MAOI) and others such as buproprion, agomelatine, reboxetine, trazadone and vortioxetine. Augmentary medications are also described, including antipsychotics, antiepileptics and lithium. Developments with the use of ketamine and other compounds are discussed.

The classification of physical treatments for depression is into neuromodulatory (e.g. electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation and phototherapy) and neuroablative techniques (e.g. stereotactic psychosurgery).