Treatment for anxiety in the elderly

The anxiety treatment The most frequently valued psychological therapy is cognitive therapy, which includes anxiety education, respiratory training and progressive muscle relaxation, cognitive restructuring to address the maladaptive worry of anxiety, and gradual exposure so that the patient can practice maneuvers to cope with worrisome situations.

Pharmacological treatment with benzodiazepines

Regarding pharmacological therapies, benzodiazepines are substances especially useful in watery stress reactions in certain situations but they are less indicated in patients with chronic anxiety symptoms.

For many years the benzodiazepines as the substances of choice in this type of disorder. However, in the 1980s a series of works highlighted the dangers that it entailed prolonged treatment with this substance, particularly in the elderly. Among these were:

• The risk of dependence and the appearance of withdrawal syndromes and tolerance phenomena
• Impairment of cognitive performance and the appearance of excessive sedation
• Increased risk of falls.

Subsequently, it has been recognized that they do play an important role in the treatment of anxiety disorders but the doses should be very mild and around 6 weeks maximum to avoid adverse effects.

Lorazepam and Oxacepam

If for any reason it is decided to start benzodiazepine treatment in an elderly person, those of choice are lorazepam and oxacepam, due to their shorter half-life, the absence of active metabolites and because age is not associated with disorders in their elimination.

Practically from the beginning of the clinical use of antidepressants, these drugs were found to be useful in the treatment of antidepressants, especially antidepressants. panic attacks and obsessive-compulsive disorders. However, the adverse effects of these drugs mean that their use in elderly patients has to be especially cautious.

Selective serotonin reception inhibitors

The second generation of antidepressants, especially selective serotonin receptor inhibitors (or SSRIs), have shown their efficacy in anxiety disorders in young patients, which allows us to suppose that they are equally effective in elderly patients. For use in anxiety disorders, the same considerations apply as for the treatment of depression, including response latency, that is, the delay in the onset of depression. clinical improvement between 15 days and 6 weeks. Treatment should be started with low doses:

• 5-10 mg / day of citalopram or paroxetine
• Escitalopram 5 mg / day

It is started with low doses to avoid exacerbating anxiety symptoms and to ensure tolerance to treatment. We are talking about 1 week from the beginning to gradually increase them to the lowest effective dose. After 4-6 weeks you should evaluate response, and if it is not satisfactory, increase the dose progressively.