Centre ressource régional de psychiatrie du sujet âgé (CRRPSA), Service de psychiatrie et d’addictologie de l’adulte et du sujet âgé, DMU psychiatrie et addictologie, AP-HP Centre-Université de Paris, France
Pôle de psychiatrie générale et universitaire, Centre de référence régional des pathologies anxieuses et de la dépression (Centre expert dépression résistante, fondation FondaMental), CH Charles Perrens, Bordeaux, Laboratoire nutrition et neurobiologie intégrée (UMR INRA 1286), Université de Bordeaux, Bordeaux, France
Inserm U1266, Institut de psychiatrie et neurosciences de Paris ; Faculté de médecine Paris Descartes, Université de Paris, France
Panic disorder in the elderly is an understudied disorder, despite being associated with substantial functional impairment, diminished quality of life and increased suicide risk in this population. This disorder is likely to be underdiagnosed and sometimes inadequately treated in the absence of national and international guidelines for this vulnerable population. Few therapeutic trials have specifically focused on the efficacy and tolerability of pharmacologic and psychotherapy treatments for panic disorder in the elderly, and current approaches to detect and manage this disorder are mainly based on experts’ opinion or extrapolation from data available in younger adults. This report aims to provide a summary of current knowledge on pharmacologic and psychotherapeutic treatments for panic disorder in the elderly, and to propose a medical treatment algorithm, which should be viewed as a tool that may contribute to the choice of treatment, especially for treatment-resistant older patients with panic disorder. The main results here are the emphasis on antidepressant treatment, like selective serotonin reuptake inhibitor (SSRI), restricted benzodiazepine usage, take care of drug interactions, and importance of psychotherapy like cognitive behavioral therapy (CBT).