Getting medications right in older adults is like rewiring a house while the power is still on: everything is connected, and one change can affect everything else.
At Advanced Psychiatry Associates offices across California, our psychiatrists work with seniors and their families to manage depression, anxiety, and memory loss with a sharp focus on safety: lower doses, fewer side effects, and fewer dangerous interactions with heart, blood pressure, and diabetes medications.
This article looks at how we approach geriatric psychiatry and medication management for seniors, so you can see how we think about:
Antidepressants and anxiety medication for older adults
Medications for dementia-related behavioral symptoms
Polypharmacy, anticholinergic burden, fall risk, and QTc issues
How our Medication Management program at APA keeps everything coordinated
Why psychiatric meds are different in older adults
In geriatric psychiatry, the rule is: Start low, go slow, but still go.
As we age:
Kidney and liver function change → drugs stay in the body longer
Brain sensitivity increases → more risk of confusion, delirium, and falls
Most seniors already take multiple medications (polypharmacy), raising the chance of drug–drug interactions and adverse effects.
The American Geriatrics Society (AGS) Beers Criteria is a key reference: it highlights medications that are often potentially inappropriate for older adults, especially drugs with strong anticholinergic effects, benzodiazepines, and some antipsychotics, because they raise risks of falls, delirium, cognitive decline, and fractures.
At APA, our geriatric prescribing always includes:
Reviewing every medication and supplement, including “just” sleep aids and allergy pills.
Looking at total anticholinergic load and sedative burden
Checking labs and, when indicated, ECGs to monitor QTc and cardiac safety
That’s what our Medication Management service is built for.
Depression in older adults: picking safer antidepressants
Depression in older adults is common but not a normal part of aging. It’s associated with disability, worse medical outcomes, and higher suicide risk, so leaving it untreated is not “safer.”
When we treat depression in older adults with medication, we usually favor:
SSRIs and SNRIs (first-line in many seniors)
Sertraline and escitalopram are often preferred SSRIs because they’re relatively well tolerated and have fewer drug interactions than some alternatives.
SNRIs such as venlafaxine or duloxetine may be considered when there is coexisting pain, with attention to blood pressure and sodium levels.
Key geriatric cautions:
Monitor for hyponatremia (low sodium), especially in patients also taking diuretics.
Watch for fall risk, especially when starting or increasing doses. Antidepressants are recognized among “fall risk–increasing drugs,” so we use the lowest effective dose and reassess regularly.
We usually avoid or minimize:
Tricyclic antidepressants (TCAs) like amitriptyline and strong anticholinergic agents, including paroxetine, appear on the Beers list due to confusion, constipation, urinary retention, and fall risk.
You can see how we frame depression more broadly here:
Advanced Psychiatry Associates Depression Services
Anxiety in elderly patients: why benzodiazepines are risky
For anxiety in elderly treatment, the reflex prescription, benzodiazepines like lorazepam or alprazolam, can be a serious problem:
Increased falls and fractures
Confusion and delirium
Worsening of memory and overall cognitive function
Higher risk when combined with opioids, alcohol, or sleep medications
That’s why the Beers Criteria recommend avoiding benzodiazepines and chronic “Z-drugs” like zolpidem, eszopiclone, and zaleplon in most older adults whenever possible.
Instead, our anxiety medication for older adults usually involves:
SSRIs or SNRIs, at geriatric-appropriate starting doses
Buspirone in selected cases (non-sedating, no dependence)
Very cautious, short-term use of sedative agents only when the risk–benefit balance justifies it
We anchor this inside our:
Advanced Psychiatry Associates Anxiety Services
We also pay attention to sleep disorders, insomnia, sleep apnea, REM behavior disorders, which are tightly linked with anxiety and medication effects in older adults
Advanced Psychiatry Associates Sleep Disorders Treatment
Memory loss, dementia, and behavior: when and how we use meds
When families come to APA for a memory loss psychiatrist evaluation, we start by sorting out:
Early dementia vs. mild cognitive impairment vs. “pseudodementia” from depression
Reversible contributors: B12 deficiency, thyroid problems, medication side effects, sleep disorders, substance use
Our dedicated Alzheimer’s & Late-Stage Dementia service focuses on:
Cognitive enhancers, e.g., cholinesterase inhibitors, memantine, where appropriate
Thoughtful use of medication for dementia-related behavioral symptoms such as agitation, aggression, or psychosis
Antipsychotics in the elderly: last resort, tightly monitored
For dementia behavior medication, we are extremely conservative with antipsychotics, because:
Atypical antipsychotics carry an FDA boxed warning for increased risk of stroke and death in older adults with dementia-related psychosis.
Alzheimer organizations recommend using them only as a last resort, when non-drug strategies have failed, and the person is at risk of harming themselves or others.
When antipsychotics are used, we:
Use the lowest effective dose and shortest possible duration
Monitor QTc interval, metabolic parameters, and fall risk
Regularly reassess the need and deprescribe if possible
That’s geriatric psychiatry in action: never “just put them on something to calm them down.”
Polypharmacy & safer prescribing: what we actually do at APA
One of the biggest hidden problems in mental health care for seniors is polypharmacy, stacking drugs from multiple specialists without a single quarterback. Studies show that many older adults receive at least one potentially inappropriate medication, even in community settings.
At Advanced Psychiatry Associates, a geriatric-focused medication visit typically includes:
Comprehensive medication reconciliation
Prescription drugs, OTC meds, vitamins, and herbal supplements
We compare against the AGS Beers Criteria and other geriatric lists to flag high-risk medicines.
Risk screen: falls, QTc, anticholinergic load
History of falls or near-falls
Dizziness, blood pressure drops, and balance problems
ECG if we’re using QTc-prolonging agents or the patient has a cardiac history
Coordination with primary care & specialists
Cardiology, neurology, and primary care are often involved
We adjust psychiatric meds with an eye on cardiac, diabetic, and blood-pressure regimens
Deprescribing when possible
Gradually reducing or stopping unnecessary sedatives, anticholinergics, or duplicate agents in line with deprescribing and NIA-supported recommendations.
This is the core of medication management for seniors in our practice, not just adding, but also editing the medication list.
Geriatric psychiatry at APA: where seniors and families start
If you’re looking for a psychiatrist for elderly patients in California, whether for depression, anxiety, memory loss, or complex medication lists, our team at APA is set up for exactly this kind of work:
Board-certified psychiatrists with experience in older adults and polypharmacy
Dedicated programs for:
Substance Abuse, including alcohol and prescription misuse
+15 offices across California, Sacramento, Los Angeles, and San Diego regions, plus telepsychiatry options:
