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Suggest Treatment For Anxiety In An Elderly Patient
Question: How can a geriatric patients anxiety be treated.I am 78 and was told by the psychiatrist I had seen, that I was "too old" now for benzodiapine meds. Was on 0.25 mg of Xanax, which helped tremendously>i have had no falls and other effects. I found it a very good medication with absolutely no side-effects. I am resentful of the notion" one size fits all" approach to treating older patients. Gabapentin9insomnia) did not help, (increased memory loss, irritable). remeron , too drowsy,low dose did not help. Any suggestions?
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
Your doctor is correct that benzodiazepines are contraindicated in patients older than 65. Benzodiazepines in all age groups but particularly in this age group lead to memory loss, poor cognition, delirium, chemical dependence, and falls and fractures.
I would suggest trying Seroquel, 25mg as needed. This is a good medication for anxiety and is safe in your age group. Alternatively, your Zoloft could simply be increased, which would be the safest and most effective treatment in the long run.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hello, and thanks for your question.
Your doctor is correct that benzodiazepines are contraindicated in patients older than 65. Benzodiazepines in all age groups but particularly in this age group lead to memory loss, poor cognition, delirium, chemical dependence, and falls and fractures.
I would suggest trying Seroquel, 25mg as needed. This is a good medication for anxiety and is safe in your age group. Alternatively, your Zoloft could simply be increased, which would be the safest and most effective treatment in the long run.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Seroquel is an anti-psychotic medication. I am not willing to risk the side effects ,even on a low dose. Have seen it first hand on a co-worker at a place of work( many years ago)
Zoloft after 10 days or so, I heard voices, nothing threatening, low volume, as if people are talking next room. No ,I do not have schizophrenia, " just" depression,but seem to have reactions -and bothersome side-effects- to many meds, SSRI's.
As I said before. I was on a low dose- (as needed) of Xanax and tolerated it well . I had been taking it for quite a while. No side effects whatsoever. No falls, no confusion, as a matter of fact I was able to think clearer when I took it-as needed-usually every other day 1 tablet, because I did not feel so anxious.
Zoloft after 10 days or so, I heard voices, nothing threatening, low volume, as if people are talking next room. No ,I do not have schizophrenia, " just" depression,but seem to have reactions -and bothersome side-effects- to many meds, SSRI's.
As I said before. I was on a low dose- (as needed) of Xanax and tolerated it well . I had been taking it for quite a while. No side effects whatsoever. No falls, no confusion, as a matter of fact I was able to think clearer when I took it-as needed-usually every other day 1 tablet, because I did not feel so anxious.
Brief Answer:
Followup
Detailed Answer:
Simply because you did not have significant side effects from Xanax in the past does not guarantee you will not have significant side effects in the future. At your age you are at increasing risk of severe side effects from Xanax, and no proficient and good doctor would prescribe it.
Seroquel was originally developed as an antipsychotic, but is now widely effective for depression, sleep, and anxiety. Low doses do not carry significant side effects.
Other medication possibilities for anxiety include buspirone (my first choice if you do not want to try SSRIs or Seroquel), propranolol, and clonidine. There are many, many options for you out there.
Alternatively, if you want to avoid medications altogether, cognitive behavioral therapy (CBT) is just as effective if not more effective than medications for anxiety. I would strongly recommend this for you as well.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
Simply because you did not have significant side effects from Xanax in the past does not guarantee you will not have significant side effects in the future. At your age you are at increasing risk of severe side effects from Xanax, and no proficient and good doctor would prescribe it.
Seroquel was originally developed as an antipsychotic, but is now widely effective for depression, sleep, and anxiety. Low doses do not carry significant side effects.
Other medication possibilities for anxiety include buspirone (my first choice if you do not want to try SSRIs or Seroquel), propranolol, and clonidine. There are many, many options for you out there.
Alternatively, if you want to avoid medications altogether, cognitive behavioral therapy (CBT) is just as effective if not more effective than medications for anxiety. I would strongly recommend this for you as well.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Thank you-
I have used Cognitive Therapy with the help of a Clinical Social Worker. I don't seem to be able to concentrate well enough ,my mind wanders, all the time, then I get upset, that I am not able to do it. Failure.
Probably will try Buspirone.
What is your opinion about TSM. I do not know if insurance would pay for it. Before I pursue it, and may be waste time, what is your professional opinion?
I have used Cognitive Therapy with the help of a Clinical Social Worker. I don't seem to be able to concentrate well enough ,my mind wanders, all the time, then I get upset, that I am not able to do it. Failure.
Probably will try Buspirone.
What is your opinion about TSM. I do not know if insurance would pay for it. Before I pursue it, and may be waste time, what is your professional opinion?
Brief Answer:
Followup
Detailed Answer:
Do you mean TMS? This is not effective for anxiety. It probably isn't worth your time.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Followup
Detailed Answer:
Do you mean TMS? This is not effective for anxiety. It probably isn't worth your time.
Please remember to rate and close this answer thread when you are finished and satisfied.
In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
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Above answer was peer-reviewed by :
Dr. Naveen Kumar
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