OPTIMAL MANAGEMENT OF ANXIETY IN OLDER PATIENTS

Although the incidence of anxiety disorders diminishes with age, the p revalence of anxiety symptoms among older patients is substantial. The se symptoms, which include cognitive and somatic manifestations, are a source of diminished quality of life. The many potential sources of i llness- and medication-induced anxiety must be excluded before institu ting treatment. The general principles of antianxiety medication treat ment in older patients include: (i) symptom relief with minimum sedati on; (ii) improvement in sleep; (iii) freedom from autonomic and cognit ive toxicities; and (iv) freedom from physical dependence and drug int eractions. Older compounds such as the tricyclic antidepressants shoul d be avoided, since more modern agents (e.g. benzodiazepines and buspi rone) are well tolerated and effective. Modern antidepressants have al so been used to reduce anxiety symptoms, although there is a potential for the opposite effect to occur. The selective serotonin reuptake in hibitors appear to be better suited to treating syndromes such as pani c and obsessive-compulsive disorder, whereas nefazodone would be a bet ter choice for generalised anxiety complicated by depression.