The research on treating anxiety disorders in older adults is limited. However, most disorders can be treated with medication or psychotherapy. For some people, a combination of medication and psychotherapy may be the best treatment approach.
Antidepressants are increasingly recommended to treat anxiety disorders in older adults. They are most commonly prescribed to treat GAD and panic disorder.
- SSRIs and SNRIs. The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa), and several others. SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).
- MAOIs. These newer drugs are more popular than the older classes of antidepressants, such as tricyclics and monoamine oxidase inhibitors (MAOIs), because they tend to have fewer side effects. However, medications affect everyone differently. Therefore, for some people, tricyclics or MAOIs may be the best choice.
People taking MAOIs must follow strict food and medicine guidelines to avoid potentially serious interactions. They must avoid substances that contain high levels of the chemical tyramine, which is found in many cheeses, wines, and pickles and in some medications including decongestants.
MAOIs interact with tyramine in a way that may cause a sharp rise in blood pressure, possibly leading to a stroke. If you are taking an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid.
If You Take Antidepressants
For all types of antidepressants, patients must take regular doses for at least three to four weeks, sometimes longer, before they are likely to feel the full benefit. They should continue taking the medication for an amount of time specified by their doctor, even if they are feeling better, to prevent the anxiety from returning.
Stopping medication should be done only under a doctor's supervision. Antidepressants need to be gradually stopped to give the body time to adjust. Some people may need to stay on the medication for a long time.
The most common side effects of antidepressant medications include headache, nausea, insomnia or nervousness, agitation or a jittery feeling, and sexual problems. Often they are mild and temporary. However, any unusual reactions or side effects that interfere with normal functioning should be reported to a doctor immediately.
Benzodiazepines are a type of anti-anxiety medication sometimes used to treat anxiety disorders in older adults. Benzodiazepines include clonazepam (Klonopin), which is used for social phobia and generalized anxiety disorder (GAD); lorazepam (Ativan), which is used for panic disorder; and alprazolam (Xanax), which is used for panic disorder and GAD.
Buspirone (Buspar) is an anti-anxiety medication used to treat GAD. Unlike benzodiazepines, however, it takes at least two weeks for buspirone to begin working.
Benzodiazepines can be habit-forming, so they should be taken with caution. Also, they tend to stay in an older adult's system longer than in younger adults, because older adults tend to have slower metabolisms. As a result, they can accumulate in the body faster than in younger adults. Therefore, benzodiazepines should only be used for a limited amount of time.
The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include upset stomach, blurred vision, headache, confusion, grogginess, and nightmares. In older adults, they can also increase the risk for falling and may cause memory problems.
For older adults who are already taking several medications for other conditions, it is important to talk with a doctor about any adverse drug interactions that may occur while taking anti-anxiety medications or antidepressants.