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Pharmacological Management of Anxiety in an Elderly Man What medication would you suggest to manage anxiety in an elderly patient with respiratory problems? (He has been taking Seraquil but I believe that it may be too sedating. He is quite sensitive to medication. There is no previous psych. Hx but he is characterologically anxious.) Thank you for your question. Unfortunately, there isn't a good answer! All of the drugs used to treat anxiety can suppress central respiration, and all have side effects and potential risks. I don't think I would use antipsychotic drugs, even generally well-tolerated ones like Quetiapine, unless there is definite psychosis (e.g., presence of delusions, hallucinations). These drugs aren't especially effective for generalized anxiety, and recently the FDA has issued a black-box warning about excess death rates in elderly patients with dementia taking second-generation antipsychotics for non-indicated behavioral problems. Your patient may not fit under that category exactly, but anxiety is still not an indicated use. SSRI antidepressants (Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram) have been shown to be helpful with specific anxiety syndromes, such as panic, phobias and sometimes obsessional anxiety, but less so with generalized or "characterological" anxiety. However, SSRI antidepressants might be worth trying for your patient, especially if you think that depressive symptoms in some way underly the anxiety picture. Benzodiazepines are effective anti-anxiety agents, but geriatricians are reluctant to start patients on them because of the development of tolerance, dependence and side effects such as confusion and ataxia; their use is associated with falls in the elderly. Under certain circumstances, short term use of a short-acting drug like Lorazepam might be considered, but if the anxiety is chronic or characterological, I do not think this would be a good idea. Buspirone, a non-benzodiazepine anxiolytic drug, is reasonably well tolerated but not especially helpful. So, there may not be a good pharmacological solution to this situation, other than perhaps trying an SSRI. You might want to consider behavioral therapies if your patient is cognitively intact and reasonably motivated.