Table 2.

Serotonin and norepinephrine reuptake inhibitors (SNRI) and other antidepressants recommended for anxiety in the elderly

Drug (Brand)	Formulation	FDA indications in anxiety	Starting Dose	Titration	Dosage Range	Side Effects
Desvenlafaxine (Pristiq)	50– 100 mg	none	50 mg every other day	Increase to 50 mg/day after 4–7 days	50 mg every other day to 50 mg every day	Nausea, dizziness, insomnia, hyperhidrosis , constipation, somnolence, anxiety, sexual dysfunction, orthostatic hypotension, hypertension, hyponatremia , elevated lipids
Duloxetine (Cymbalta)	20, 30, 60 mg	GAD	20 mg/day	Increase by 20 mg after 7 days	20–60 mg	Nauseas, dry mouth, constipation, poor appetite, diarrhea, headache, insomnia, somnolence, fatigue
Venlafaxine (Effexor)	25, 37.5, 50, 75, 100 mg XR: 37.5, 75, 150 mg	GAD, Social anxiety disorder, Panic disorder	IR: 25mg XR: 37.5 mg/day	IR: Increase by 25 mg every 4–7 days as tolerated to 25 mg tid; if response is inadequate after 3 more weeks, increase slowly to 75 mg tid XR: Increase to 75 mg (target dose) after 4–7 days; may need to increase to 150 mg or 225 mg if response is inadequate	IR: 50 mg tid XR: 150 mg/day	headache, dizziness, insomnia, hot flush, hyperhidrosis , nausea
Vortioxetine (Trintellix)	5, 10, 20 mg	none	5mg/da y	May increase to 10mg/day	5– 10mg/da y	Nausea, constipation, vomiting
Mirtazapine (Remeron)	Tablets: 7.5, 15, 30, 45mg OD tablets: 15, 30, 45 mg	none	7.5mg qpm	Increase 7.5–15mg every 1–2 weeks	7.5– 45mg/da y	Somnolence, increased appetite with weight gain, increased serum cholesterol, constipation, dry mouth.