Table 36.2

Table 36.2—Treatment Strategies for Anxiety Disorders in Late Life

Disorder	First-Line Treatments	Second-Line Treatments
Panic disorder with or without agoraphobia	SSRIs,* SNRIs,* CBT	Newer antidepressants, benzodiazepines**
Social phobia
Generalized	SSRIs* or phenelzine^OL plus CBT	Benzodiazepines**
Specific	β-blockers plus CBT	Buspirone
Simple (specific) phobia	CBT or benzodiazepines**	β-blockers
Obsessive-compulsive disorder	SSRIs* plus CBT	Clomipramine, combination pharmacotherapy
Posttraumatic stress disorder	SSRIs* or SNRIs*	CBT, newer antidepressants
Generalized anxiety disorder	SNRIs,* SSRIs,* CBT	TCAs, benzodiazepines,** newer antidepressants
Anxiety and medical disorders	Identify and treat underlying cause, use SSRIs* or SNRIs* in primary anxiety disorder	Benzodiazepines**
Mixed anxiety depression	SSRIs* or SNRIs*	Buspirone, benzodiazepines,** CBT
Anxiety and agitation in dementia	Atypical antipsychotics^OL or trazodone^OL	Benzodiazepines,** anticonvulsants

* Not all SSRIs and SNRIs are approved for anxiety disorders or all types of anxiety disorders. For example, the SSRI escitalopram is not approved for anxiety, nor is the SNRI duloxetine.

** Preferably, benzodiazepines with a short half-life and no active metabolites (eg, lorazepam).

NOTE: CBT = cognitive-behavioral therapy; SNRIs = serotonin–norepinephrine reuptake inhibitors (eg, venlafaxine); SSRIs = selective serotonin-reuptake inhibitors (eg, sertraline); TCAs = tricyclic antidepressants.