Antidepressants may be the preferred choice to treat anxiety in older adults, according to the results of a meta-analysis published in the Lancet Psychiatry. Further, selective serotonin reuptake inhibitors (SSRIs) may produce more pronounced symptom improvements than serotonin norepinephrine reuptake inhibitors (SNRIs), though both types have similar chances of producing anxiety remission.
Sarah E. Neil-Sztramko, Ph.D., of McMaster University in Hamilton, Ontario, and colleagues compiled data from 19 randomized clinical trials assessing anxiety medications in adults ages 60 and older; the combined sample included 2,336 participants (68% female), primarily with generalized anxiety but also some with panic disorder or agoraphobia. Nine of the trials tested antidepressants, four tested benzodiazepines, and the remainder tested quetiapine, pregabalin, or buspirone.
The researchers found that antidepressants as a group were superior to placebo or waitlist control at reducing anxiety symptoms. Overall, 40% of participants taking antidepressants achieved a response (50% or greater reduction in symptoms) or anxiety remission compared with 24% of those on placebo or waitlist. SSRIs produced greater anxiety symptom improvements over control groups compared with SNRIs, though both classes showed similar rates of response and remission.
“In contrast, findings from other drug classes indicated low certainty evidence for the use of quetiapine and buspirone, and very low certainty evidence for pregabalin and benzodiazepines,” Neil-Sztramko and colleagues wrote. “In conjunction with the use of non-pharmacological interventions, our findings indicate antidepressants should be the first-line pharmacological treatment for anxiety disorders and clinically significant anxiety symptoms in older adults, aligning with guidelines for the general adult populations.”
The researchers said that their analysis was limited by the small number of available studies, most of which were published before 2012. The included studies also had fragmented data on side effects and tolerability, so the analysis could not definitively state the safety profile for these medications.
“Despite limitations, this review and meta-analysis has synthesized the best available evidence to help inform clinical guidelines and has drawn attention to the scarcity of recent, high-quality studies, studies of difficult-to-treat anxiety, and pragmatic trials in older adults,” they concluded.
For related information, see the Focus article “Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance.”
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