Anxiety Medication for the Elderly: Precautions and Considerations

Anxiety disorders can be overwhelming and are often misunderstood. Rather than simply meaning that people are anxious (a challenge we all face occasionally), an anxiety disorder makes many tasks overwhelming, if not almost, potentially contributing to social isolation and depression.

These conditions aren’t limited to the young. Instead, they can affect anyone regardless of age, with between 10% and 20% of the older population suffering from some degree of anxiety.

Anxiety disorders in older adults may go untreated more often than normal as well, in part due to perspectives on mental health. In particular, many seniors come from a background where mental health was traditionally not talked about and emotional challenges were ignored.

As a result, family members may need to keep an eye out for the symptoms of anxiety in seniors and encourage their loved ones to seek treatment.

Treatment Options for Anxiety

The exact treatment approach depends on the senior and the specific form of anxiety they are suffering. Generalized anxiety disorder (GAD) is a common form of anxiety among seniors, but there are many others.

Treatment options include several types of medications, psychotherapy, and supporting lifestyle modifications.

Telemedicine has improved treatment approaches, giving doctors the chance to help seniors remotely more often. It’s even possible to purchase anti-anxiety medications online, although care needs to be taken to ensure the right medication is chosen.

In-depth discussions about medications are also needed before any prescription. This is crucial, as medication is not always the best way to treat anxiety. When medication is used, it is typically part of a larger plan of care.

Causes of Anxiety in Seniors

Anxiety typically doesn’t come from a single cause. Instead, a variety of factors can raise a senior’s risk of developing an anxiety disorder, including excessive worry over poor health, chronic medical conditions, side effects of medications, and limitations in daily activities. Anxiety may also develop as a result of trauma, an adverse event, or due to other factors.

Seniors who spend considerable time alone may also be more likely to develop anxiety disorders, because they spend a lot of time in their own heads and don’t have the chance to talk things through with others.

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.

Things to Consider with Anxiety Medication for Seniors

Potential Reactions to the Medication

Adverse reactions are possible for any medication. That’s why most come with a long warning label and why it’s important to match the medication to the patient.

Older adults face some important challenges in this area.

First, they may be more sensitive to a given drug dose. As a result, 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.

Interactions

There’s also the chance of interactions between the medication and an underlying health condition or between medications the senior is currently taking.

These issues are especially significant for seniors, as many are taking multiple types of medication at once, some of which might not even be needed. As such, it’s crucial that the senior’s doctor carefully evaluates current medications to decide whether an anti-anxiety drug is the right fit.

The Role of Therapy

As mentioned earlier, anxiety often isn’t treated with medication alone. All medication does is change the senior’s physical responses. More work is needed to determine where the anxiety disorder comes from and to help the senior come back to more balanced responses.

Some seniors may not need medication at all. Others may need it only for a time. Then, as their therapy and lifestyle changes start to take effect, they may be able to decrease their medication dose and eventually stop taking it entirely.

Besides the general considerations, clinicians should consider patient-specific factors for each senior. This includes past trials and responses to 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)

SSRIs and SNRIs are generally the first choice when treating anxiety in seniors, while other medications are used situationally.

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. Similarly, benzodiazepines can sometimes be prescribed for anxiety, but come with concerning side effects for seniors, including increased fall risk.

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 talk with their doctor.

Short-term mild side effects may simply be the result of the senior adjusting to the medication and will naturally decline over time. Severe or prolonged side effects suggest that a different type of medication is needed.

Common side effects include nausea, headaches, fatigue, insomnia, decreased appetite, and decreased libido. Thankfully, these side effects are often minor and often much less than the effects of anxiety.

Caregivers should also keep an eye on anxiety symptoms. While these medications are meant to decrease anxiety, some seniors might experience increased anxiety instead.

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 discontinuing medication. The doctor should gradulally taper the medication for a few weeks before the discontinuation and closely monitor 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.