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Medications

When medication is indicated SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and escitalopram (Lexapro) are generally recommended as first line agents. SNRIs such as venlafaxine (Effexor) are also effective. Benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin) and diazepam (Valium) are also sometimes indicated for short-term or PRN use. They are usually considered as a second line treatment due to disadvantages such as cognitive impairment and due to their risks of dependence and withdrawal problems. MAOIs such as phenelzine (Nardil) and tranylcypromine (Parnate) are also considered an effective treatment and are especially useful in treament resistant cases, however dietary restrictions and medical interactions may limit their use. There is also evidence that certain newer medications including the GABA analogue pregabalin (Lyrica), and the novel antidepressant mirtazapine (Remeron) are also effective treatments for anxiety disorders. TCAs such as imipramine, as well as atypical antipsychotics such as quetiapine, and piperazines such as hydroxyzine are also occasionally prescribed.

These medications need to be used with extreme care among older adults, who are more likely to suffer side effects because of coexisting physical disorders. Adherence problems are more likely among elderly patients, who may have difficulty understanding, seeing, or remembering instructions.

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