An Evidence-Based Approach to Psychopharmacology for Generalized Anxiety Disorder in Older Adults-View Presentation

Video Transcription

Video Summary

The presentation discusses a newly developed algorithm for treating generalized anxiety disorder (GAD) in older adults, created by the Psychopharmacology Algorithm Project at Harvard South Shore. The algorithm, which is currently under review for publication, seeks to offer evidence-supported guidance specifically for the elderly population, distinct from treatments for younger adults. Key presenters included Dr. David Ossor, who introduced the basic structure of the algorithm; Dr. Anderson Chen, who elaborated on the first and second treatment steps; and Dr. Aaron Metzger, who addressed treatment-resistant cases.<br /><br />The algorithm begins by diagnosing GAD using the DSM criteria, then evaluating possible comorbidities like sleep disturbances, depression, or COPD, which can affect treatment choices. The first-line medications suggested include SSRIs, specifically escitalopram and sertraline, due to their efficacy and safety profile in older adults. Alternatives like buspirone or duloxetine (with considerations for minimizing sexual side effects) are also explored. If these initial options are ineffective, the algorithm advises a personalized approach using other SSRIs, SNRIs, or agents such as pregabalin or gabapentin, despite their limited evidence base.<br /><br />The algorithm advocates caution with benzodiazepines and antipsychotics due to potential side effects, including sedation and increased fall risk, while highlighting the importance of monotherapy over polypharmacy to avoid interactions common in older patients. It provides insights into lesser-known options like lavender oil and kava, acknowledging their potential merits and risks. Throughout, the algorithm stresses individualized treatment decisions based on each patient's specific circumstances, comorbidities, and preferences.

Keywords

generalized anxiety disorder

GAD

older adults

Psychopharmacology Algorithm Project

Harvard South Shore

SSRIs

escitalopram

sertraline

treatment-resistant

comorbidities

monotherapy

personalized treatment

benzodiazepines