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George T. Grossberg, MD

Primary Psychiatry. 2004;11(8):26

Primary care physicians (PCPs) in the United States are being increasingly confronted by the “graying” of the American population. With the aging of the post-World War II baby boomers, the percentage of older adults seen by PCPs has grown exponentially. In addition to this demographic trend, older adults continue to live longer and stay healthier than ever before. Younger adults as a rule do not get sick often; rather, it is frequently the old-old (those >85 years of age) who are seen for a variety of illnesses by PCPs.

Though individuals >65 years of age constitute approximately 13% of the current population, they consume three times their numbers of prescribed medications and consume nearly 50% of all over-the-counter (OTC) remedies in the US. It is not uncommon for PCPs to encounter older outpatients, as well as those in long-term care, who may be on a half-dozen or more prescribed medications and several other OTC remedies. Furthermore, many of the medications that older adults may be taking are psychotropic or have a primary indication for a psychiatric disorder. These commonly prescribed medications may have mood or mind-altering side effects in this vulnerable patient population. Consequently, it is important for PCPs to be updated relative to recent research in the area of psychopharmacology and aging.

In the first article of this issue, Abhilash K. Desai, MD, discusses the important topic of psychotropic side effects of commonly prescribed drugs in the elderly. He focuses particularly on medications that are linked to delirium, changes in mood, and which may trigger psychotic symptoms in this population.

The second article by Prasad R. Padala, MD, and colleagues, focuses on the use of antidepressants in geriatric patients. There have been several newer antidepressants approved recently by the Food and Drug Administration. It is important for PCPs to be aware of how to utilize these available antidepressants in the older adult population and of the common drug-drug interactions that may occur in older patients.

Next, Ben Zimmer, MD, discusses the important topic of the use of anticonvulsants and mood stabilizers in bipolar illness in the elderly. The instances of bipolar affective disorder among older adults have increased in recent years. Primarily, these are individuals who have had a life-long history of bipolar affective disorder; however, on occasion, PCPs may see new-onset mania or bipolar disease in people >65 years of age. The appropriate use of the anticonvulsants and/or mood stabilizers, as well as the safe use of these agents, is discussed in this article.

In the next article, David P. Folsom, MD, and colleagues discuss the appropriate use of antipsychotics in the older population. This is an area that is currently meriting a lot of attention; recent reports have attributed metabolic as well as cerebrovascular risks to some of the newer or atypical antipsychotic medications.

Javaid I. Sheikh, MD, then discusses in detail the appropriate use of anxiolytics and sedative hypnotics in older patients. Anxiety symptoms as well as sleep disturbances are quite common in the geriatric population. This is an area that has received less attention recently, since there has not been a new anxiolytic/sedative hypnotic approved by the FDA in many years. The currently available agents have potential liabilities for older adults and Dr. Sheikh discusses these.

With the aging of the population, the incidence of various dementing disorders, in particular Alzheimer’s disease, is increasing. In addition, several new antidementia drugs have been approved by the FDA in the past several years. Consequently, it is imperative for PCPs to be familiar with the up-to-date treatment approaches and options for older patients with dementing illnesses. Sanjeev M. Kamat, MD, and colleagues conclude the issue by tackling this important area of antidementia agents. They discuss the currently available compounds and future options emerging on the treatment horizon.

This issue of Primary Psychiatry is an exceedingly important one not just for PCPs, but for all healthcare providers who care for the older adult population. It covers the highlights of psychopharmacology and aging by sharing with the reader important areas that are seen in the clinical setting. Hopefully, these articles will enable healthcare providers to more appropriately take care of their vulnerable geriatric patients. PP

Dr. Grossberg is Samuel W. Fordyce Professor and Director of Geriatric Psychiatry at Saint Louis University School of Medicine in Missouri.

Disclosure: Dr. Grossberg is a consultant for Abbott, AstraZeneca, Bristol-Myers Squibb, Forest, Janssen, Novartis, and Sanofi-Synthelabo; and receives grant and/or research support from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Eunoe Incorporated, Forest, GlaxoSmithKline, Janssen, Novartis, ONO Pharma, Pfizer, and Wyeth.

Please direct all correspondence to: George T. Grossberg, MD, St. Louis University School of Medicine, Department of Psychiatry, 1221 South Grand Blvd, Rm 212, St. Louis, MO 63104; Tel: 314-577-8721; Fax: 314-268-5490; E-mail: