Andrew Chen, MD: Taking More Adverse Event Prone Anxiety Medications

Although serotonin reuptake inhibitors (SSRIs) are the preferred treatment option for generalized anxiety disorder (GAD), some patients might not experience benefits from these drugs and will need to turn to more adverse event prone anxiety medications to relieve symptoms.^1,2

Andrew Chen, MD, from the Geriatric Psychiatry Department at Massachusetts General Hospital, presented this topic at the session “An Evidence-Based Approach to Psychopharmacology for Generalized Anxiety Disorder in Older Adults” at the annual American Psychiatric Association (APA) conference on Wednesday, May 8.

In an interview with HCPLive, Chen discussed why patients might need to be prescribed a more adverse event prone anxiety medication. He explained how patients start with a low dose, and if there is a partial positive response, the psychiatrist might increase the dose. If there is no positive response after increasing to the maximum dose, it is recommended to try a new anxiety medication.

“Our algorithm is an individualized decision,” Chen said.

If a patient is at risk of being hospitalized that day or that week due to their anxiety, they would need an adverse event prone anxiety medication—such as quetiapine, risperidone, or aripiprazole—as there is no time to try an SSRI since they may take 6 – 8 weeks to provide a partial response.

“So, in those situations, you might have to jump to medicines that are, you're already not stronger,” Chen said. “Because those medications that day that you take it, you will feel something.”

Risperidone is associated with high risks for older adults. The medication has a US Food and Drug Administration (FDA) blackbox warning for older adults for all risk of death, including a stroke, and a risk of movement issues. It is also addictive.

“Every year you're on it, [the] risk just keeps going up and up,” Chen said.

Chen recommends older adults on a medication like risperidone to also be taking a medication with a better side effect profile like SSRIs since it will take time to go in effect.

“The impression I want to give to the listeners is that use our algorithm as a guide,” Chen said. “Our algorithm has all the evidence to support the use of each medicine, and once you know the rules…this is not a very rigid structure. You really have to tailor it to the patient's needs.”

References

1. ^{Chen, A. An Evidence-Based Approach to Psychopharmacology for Generalized Anxiety Disorder in Older Adults. Session presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 8, 2024.}
2. ^{Ansara ED. Management of treatment-resistant generalized anxiety disorder. Ment Health Clin. 2020;10(6):326-334. Published 2020 Nov 5. doi:10.9740/mhc.2020.11.326}