Anxiety disorders can affect anyone regardless of age, and anxiety in the elderly is not unusual. Indeed, these conditions affect nearly 4% of the older population globally. Of all the anxiety disorders, generalized anxiety disorder (GAD) is most common among the elderly and can have notable negative effects.
There are many treatment options available for treating anxiety. These include several types of medications, psychotherapy, and supporting lifestyle modifications. When choosing the best anti-anxiety medication for elderly patients, doctors take many precautions into account. Below is a review of the most important ones.
Understanding Anxiety in the Elderly
Many risk factors increase an older adult’s chances of developing an anxiety disorder. These include excessive worry over poor health, chronic medical conditions, side effects of medications, and limitations in daily activities. Anxiety may also develop as the result of trauma, of an adverse event, or due to other factors.
Some common signs and symptoms of anxiety in the elderly include:
- Irrational worry and fear
- Avoidant behavior
- Misuse of alcohol or prescription medication
- Sleep disturbances
- Depression
- Weakness
- Muscle tension and pain
Older patients are susceptible to experiencing dyspnea, tachycardia, and digestive issues as anxiety symptoms. Anxiety in older adults may inhibit their ability to perform daily activities and diminish their quality of life. It can worsen physical health, contribute to cognitive impairment, and reduce feelings of overall well-being. With the accessibility of care brought on by telemedicine, they have more chances to manage the disorder and its outcomes, which includes getting anti-anxiety medications online along with plenty of anxiety support.
Factors to Consider When Medicating Elderly Patients
Older patients may be more sensitive to a given drug dose. Therefore, it’s not unusual that starting doses of antidepressants and anti-anxiety medications in the elderly are lower than in younger patients.
The effects of a drug might also take longer in older patients. While moderate improvements may be seen starting from week four, it may take up to twice as long to establish the full benefits of a medication for the elderly.
Besides the general considerations, clinicians consider patient-specific factors for each elderly patient. This includes past trials and responses to medication and tolerability of the medication.
Commonly Prescribed Anxiety Medications
There is no best anxiety medication for elderly because every patient’s situation differs. Clinicians choose from many options and consider the safety profile of each medication. Important factors include potential side effects and possible drug-drug and drug-disease interactions.
Anxiety medication for the elderly typically includes antidepressants such as serotonin-norepinephrine uptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs). The list of the most commonly prescribed ones is as follows:
- Buspirone (Buspar)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Duloxetine (Cymbalta)
- Sertraline (Zoloft)
- Mirtazapine (Remeron)
- Venlafaxine (Effexor)
While approved by the FDA, some anxiety medications are listed in the AGS Beers Criteria® as potentially inappropriate for older patients. They may not be the safest anti-anxiety medication for elderly patients for several reasons. For example, if bupropion is taken by an elderly patient having depression and anxiety disorder, it can worsen their anxiety symptoms.
Risks and Side Effects of Anxiety Medication
Anxiety medication for elderly patients can cause side effects. Every patient must keep a record of such effects, and if they become unbearable, it’s crucial to inform a doctor as soon as possible.
Here is a summary of the common side effects of some anti-anxiety medications for the elderly.
1. Buspirone (Buspar)
- Lightheadedness
- Headache
- Dizziness
- Nausea
2. Escitalopram (Lexapro)
- Fatigue
- Drowsiness
- Decreased libido and ejaculation disorder
- Nausea
- Insomnia
3. Duloxetine (Cymbalta)
- Nausea
- Decreased appetite
- Excessive sweating
- Drowsiness
- Dry mouth
4. Sertraline (Zoloft)
- Nausea
- Excessive sweating
- Decreased appetite
- Decreased libido and erectile dysfunction
- Diarrhea
5. Venlafaxine (Effexor)
- Nausea
- Dry mouth
- Drowsiness
- Loss of appetite
- Decreased libido, erectile dysfunction, and abnormal ejaculation
6. Mirtazapine (Remeron)
- Dry mouth
- Nausea
- Increase in appetite and consequent weight gain
- Drowsiness
- Headaches
As outlined, the common side effects of anxiety medication for elderly patients are generally mild and well-tolerated. In addition to these side effects, there is always a risk of dependence, so it’s important to tread carefully.
How to Reduce the Risk of Side Effects
Older patients can reduce and manage the risk of side effects from anxiety medication by using the following strategies:
- Providing a doctor with a list of all current prescription and over-the-counter medications to reduce the risk of drug-drug interactions.
- Disclosing other medical and psychological conditions to reduce the risk of adverse drug-disease interactions.
- Keeping a record of all side effects and seeking expert advice from the doctor.
- Following all instructions on taking the medication. This helps with the side effects and ensures the medication is as effective as possible.
Check-Ups and Monitoring: Why It Is Important
Some anti-anxiety medications for elderly patients have additional precautions, which call for close monitoring. Older patients are also more sensitive to the side effects of anxiety medication, and monitoring allows the doctor to track these side effects. The doctor can then decide whether to keep the patient on the same medication and gradually alter the dosage or change the medication.
Anxiety among older patients is also commonly associated with different medical and psychiatric conditions. For example, studies have demonstrated the relationship between anxiety and cardiovascular risk. Similar studies have focused on psychiatric disorders such as depression and dementia. Routine check-ups for such conditions can help the healthcare provider catch the problems early and develop a proper treatment plan.
There is a dependence risk for anxiety medication. Older patients may misuse the medication to get faster results for symptoms such as sleep disturbance and other signs that may cause functional impairment. Close monitoring, patient education, and talk therapy will help patients avoid or overcome medication misuse.
Close monitoring is also critical when discounting medication. The doctor provides a gradual taper for a few weeks before the discontinuation and closely monitors the patient to avoid relapse of anxiety symptoms.
The Wrap-Up
Several anxiety medications, including escitalopram, sertraline, buspirone, duloxetine, and venlafaxine, can help treat anxiety in older patients. Patients must work with a doctor to determine the best option based on factors such as potential drug interactions, how long it may take to see the effects of the medication, and the expected type and severity of side effects.
As pointed out, managing anxiety in older patients with medication also presents unique challenges that practitioners must consider when prescribing the medication for the best outcome. The doctor must also closely monitor the patient and recommend regular check-ups. Full cessation of the anxiety signs and symptoms will have considerable benefits and positively impact patients’ quality of life.
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