MANAGEMENT OF ANXIETY AND DEPRESSION SYNDROMES IN THE ELDERLY

Elderly patients are susceptible to disruptions in mood from a variety of sources: primary anxiety or mood disorders, medical illnesses and treatments, and psychosocial stressors. The goals of intervention are to discover reversible etiologies, treat in the least intrusive manner , and improve or restore quality of life. The clinical presentation ma y vary from typical anxiety or depression, to mixed symptoms, to a hig hly somatized or dementia-like picture. The most common disturbance is mixed anxiety/depression. Once the threshold is reached for drug ther apy, there are safe and effective remedies, including azapirones, shor t-acting benzodiazepines, serotonin reuptake inhibitors, and others. B ecause elderly patients are more vulnerable to drug side effects such as sedation and orthostatic hypotension, selection of the therapeutic agent is crucial. Management strategies, therefore, tend to avoid seda ting agents and those with strong autonomic effects. Antipsychotic dru gs, unless specifically indicated-for example, in cases of delusional depression-are to be avoided in simple anxiety/depression syndromes. P rescribers for patients in nursing facilities must also observe Omnibu s Budget Reconciliation Act (OBRA) regulations. These include preferen ce for psychosocial over drug therapies, avoidance of physical and che mical restraint, and minimal use of any psychotropic medication.