Recent developments in geriatric psychopharmacology

ABSTRACT

Introduction

There is a tremendous growing need to address the burden of geriatric psychiatric disorders. Recent developments relevant to geriatric psychiatry have focused on Alzheimer’s disease (AD), severe/refractory depression, and cancer/end of life care.

Areas covered

This is a non-systematic, narrative review (databases and websites for search: PubMed, Google Scholar, Medscape, ClinicalTrials.gov; focusing on the last 6 years), and covers developments in disease-modifying therapies for AD, diagnostic radiotracers for AD, medications for neuropsychiatric symptoms of dementia, ketamine/esketamine, psychedelics, and cannabinoids.

Expert opinion

The focus of on-going trials of anti-amyloid agents has been on individuals with very early stage AD; several agents are under phase 3 investigation, and aducanumab is under FDA review. Amyloid and tau PET scans have been approved by the FDA to assist in the diagnoses of AD. Promising pharmaceuticals for neuropsychiatric symptoms of dementia include pimavanserin, brexpiprazole, escitalopram, dextromethorphan/quinidine, and lithium. Esketamine, although approved for treatment-resistant depression in general adults, failed to demonstrate efficacy in elderly patients in a phase 3 trial. There is preliminary evidence for benefit of psychedelic-assisted psychotherapy in end-of-life and cancer-related depression/anxiety. Evidence for the use of cannabinoids is currently lacking.

KEYWORDS:

• Geriatric psychiatry
• psychopharmacology
• Alzheimer’s disease
• dementia
• anti-amyloid agents
• diagnostic radiotracers
• neuropsychiatric symptoms
• treatment-resistant depression
• psychedelics
• esketamine
• cannabinoids

Article highlights

• Several anti-amyloid agents have been and are being investigated as treatments for Alzheimer’s disease, (aducanumab is currently under FDA review).

• Amyloid and tau PET radiotracers are available to aid the diagnosis of Alzheimer’s disease.

• Promising agents under investigation for treatment of neuropsychiatric symptoms of dementia include pimavanserin, brexpiprazole, escitalopram, mirtazapine, dextromethorphan/quinidine formulations, lithium and gabapentin.

• Esketamine, although approved by the FDA for use in general adults, failed to demonstrate efficacy in phase 3 trial specifically conducted in elderly patients with treatment-resistant depression.

• There is preliminary evidence that psychedelics may be beneficial in the treatment of end of life and cancer-related depression and anxiety.

• Evidence for the therapeutic use of cannabinoids in the elderly is currently lacking.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.