Treatment of anxiety disorders in the elderly: issues and strategies

Clinical practice for the treatment of anxiety disorders in the elderly in general lacks empirical validation and hence is somewhat inconsistent. Extensive clinical experience, along with the knowledge gleaned from studies with a younger population, has led to the development of the following treatment approach. A thorough diagnostic assessment, crucial in planning subsequent treatment, is discussed first along with more general clinical issues. Next. a detailed review of current pharmacologic and psychologic treatments for each of the diagnostic categories of anxiety is described for application to the older patient. Definitive studies regarding the best treatments for anxiety disorders in the elderly are lacking, and further investigation of this area is emphasized.

Imipramine in the treatment of social phobia

We report the results of an 8-week open trial of imipramine in 15 patients with social phobia. Nine patients completed the trial; six dropped out early because of adverse effects. The mean reduction in the Liebowitz Social Anxiety Scale was 15% and 18% for the intent-to-treat and completer groups, respectively; the overall response rate (based on the Clinical Global Impression Scale of 1 or 2, very much or much improved) was 20% (3/15) and 22% (2/9), respectively. The results from this open trial do not support the efficacy of imipramine as a treatment for social phobia.