Paranoid Symptoms Among Older Adults

Muzumel A. Chaudhary, MD; Kiran Rabheru, MD, CCFP, FRCP, ABPN


Geriatrics and Aging. 2008;11(3):143-149. 

In This Article

Depression with Psychotic Features

In the case of depression with psychotic features, there is strong evidence for the use of combination therapy with both an antidepressant (selective serotonin reuptake inhibitors, venlafaxine, or mirtazapine) and an atypical antipsychotic agent (risperidone, olanzapine, or quetiapine). Care is essential given the increased sensitivity of older persons to atypical antipsychotic medications, and adverse effects (extrapyramidal symptoms and tardive dyskinesia) must be monitored closely. As older adults have significantly higher blood levels of neuroleptics than younger individuals given similar doses,[5] when used, it is critical to prescribe neuroleptics in doses that are considerably lower than those used in younger adults and slowly increased to effect (Figure 2).

Figure 2.

Paranoia: Depression with Psychotic Features

Psychotic (delusional) depression in older adults does not always respond to pharmacotherapy, and there are often issues of poor medication tolerability in this cohort. As such, electroconvulsive therapy may be considered as an alternative treatment modality for older depressed individuals with psychotic features, particularly when associated with suicidal ideation or physical illness.[25] Electroconvulsive therapy is considered equally, if not more, effective in treating depression when delusional features are present.[25]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.