Anxiety Disorders

Selective serotonin re-uptake inhibitors (SSRIs) are inappropriate to use in patients aged 65 years and older with current or recent significant hyponatraemia i.e. serum Na+ < 130 mmol/l (risk of exacerbating or precipitating hyponatraemia).

Tricyclic antidepressants (TCAs) are inappropriate to use in patients aged 65 years and older: 

  • if they have dementia, narrow angle glaucoma, cardiac conduction abnormalities, prostatism, or prior history of urinary retention (risk of worsening these conditions)
  • for initiation as first-line antidepressant treatment (higher risk of adverse drug reactions with TCAs than with SSRIs or SNRIs)
  • if concomitant use of two or more drugs with antimuscarinic/anticholinergic properties (e.g. bladder antispasmodics, intestinal antispasmodics, tricyclic antidepressants, first generation antihistamines) (risk of increased antimuscarinic/anticholinergic toxicity

All patients should be told about the side effects of antidepressants, particularly the possibility of an increase in suicidality, restlessness or agitation

All patients should be informed about the withdrawal (discontinuation) effects of antidepressants

For people with learning difficulties initiate treatment with low doses and titrate cautiously with frequent monitoring for side effects

Additional resources

British Association for Psychopharmacolgy Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder

NICE CG113 Guidance for generalised anxiety disorder and panic disorder (with or without agoraphobia)

NICE CG159 Social anxiety disorder: recognition, assessment and treatment

NICE NG116 Post-traumatic Stress Disorder

NICE CG31 Core interventions in the treatment of OCD and body dysmorphic disorder

Formulary medications