Are Meds for Depression and Anxiety Safe For Older Adults?

A lot has been written about serious problems that occur when patients take many different medications. This is called poly-pharmacy. Doctors are often unaware of the other doctors their patients see and the medications they take. A watchful and proactive pharmacist may spot a potential medication problem—if the patient has all their prescriptions filled at one pharmacy. But all too often this does not happen.

However, one type of doctor older adults should see more of is a psychiatrist. A recent article that appeared in the Journal of the American Geriatrics Society reports that older adults are prescribed twice as much medication for mental health conditions, such as anxiety and depression, as younger adults—and are more likely to receive treatment for mental health issues from a primary care doctor than from a psychiatrist or other mental health professional.

Clearly older adults are receiving treatment for mental health problems, which is a good thing. However, the findings presented in the article suggest that they may not be getting the right mental health treatment. A psychiatrist, rather than a primary care doctor, is more likely to have the type of training to evaluate which medications, if any, are appropriate for an older adult. In general, older adults do not metabolize medications in the same way as younger people so dosages may have to be modified. In addition, certain types of anti-depressive and anti-anxiety medications can produce serious side-effects in older adults. Importantly, because of the risks that many psychotropic pose for older adults, the article suggests that it might be just as effective–and safer to–use talk therapy to complement or even substitute for medication use.

If you or another family member over age 65 is taking medication for anxiety, depression, or another mental health condition and if the prescribing doctor is not a geriatric psychiatrist, it is important to discuss potential drug interactions and side effects with your pharmacist and physician. I’m not sure why people who would never use their primary care doctor to treat a heart or liver condition feel that it is perfectly fine to have a primary care doctor prescribe psychotropic medications for a mental condition. The article does not speculate on a reason for this choice. Could stigma be a factor?

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