26 - Treatment of late-life generalized anxiety disorder

Summary

This chapter focuses on the specific problems encountered in treating late-life generalized anxiety disorder (GAD). The most common elements of Cognitive-behavioral therapy (CBT) are didactic information about anxiety and instruction in self-monitoring of anxiety, relaxation training, imaginal relaxation, cognitive therapy, worry behavior prevention, problem solving, and gradual exposure to anxiety-provoking stimuli. Selective serotonin reuptake inhibitor (SSRIs) and serotonin-norepinephrine reuptake inhibitor (SNRIs) have replaced tricyclic antidepressants with proven efficacy for GAD as first-line agents. Pharmacotherapy remains the most widely used treatment for managing late-life anxiety. CBT is the best-supported psychosocial treatment for anxiety disorders in younger adults, as well as the best potential alternative to medications. The treatment of GAD is challenging in general, and particularly in the elderly. In all pharmacotherapy, the lowest dosage of medication that controls the patient's symptoms should be prescribed. Insomnia is a frequent symptom of GAD and should be addressed specifically.