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Introduction Neuropsychiatric disorders affect millions of older adults. Despite this, there are relatively few older adults included in clinical trials evaluating treatments for psychiatric disorders. Citalopram has been evaluated in older adults with neuropsychiatric disorders and has largely been found beneficial, making the 2011 US Food and Drug Administration (FDA) safety advisory on citalopram extremely impactful. Methods A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English. Results Review of the literature confirms the efficacy of citalopram in depression, anxiety, depression associated with Parkinson disease, and behavioral and psychological symptoms of dementia. Additionally, no adverse cardiac outcomes have been described related to citalopram. Discussion The FDA's evidence for applying this safety advisory to citalopram is minimal and largely based on surrogate markers, such as the QTc interval rather than clinical and safety outcomes. Citalopram is known to increase the QTc, but this increase has not been linked to adverse cardiac outcomes. The evidence for efficacy and against adverse outcomes suggests that a reevaluation of the dosing restrictions in older adults with neuropsychiatric disorders is needed.

The population of older adults with bipolar disorder is growing, not only because of the increase in the percentage of the population 65 years of age and older, but also because of an increase in awareness about mental health issues in this population. For years, lithium has been one of the first-line options for treating bipolar disorder, but data in the older population have mostly been inconclusive or extrapolated from younger populations. Questions of tolerability and safety in the older adult have also arisen, as well as its efficacy in comparison to newer agents on the market. This manuscript aims to examine the evidence of lithium use in the older adult and whether or not this drug should still be recommended for use in this population.

As persons age, their risk of developing late-life depression increases. Older adults not only have an increased risk of late-life depression, but they also have an increased risk of suicidal ideation. Because of these increased risks, it is vital that clinicians be aware of the options available to assist these persons to achieve remission of their symptoms, as well as prevent relapse. Atypical antipsychotics have been considered an augmentation option in younger adults with depression. However, because of the black box warning associated with atypical antipsychotics in older adults with dementia, clinicians often exercise caution when using these agents to help treat late-life depression. This article explores the various studies conducted for the use of atypical antipsychotics in older adults and their safety and efficacy in this population.

Adults older than 65 years of age with vision impairment are more likely to have difficulty managing medications compared with people having normal vision. This patient population has difficulty reading medication information and may take the wrong medication or incorrect doses of medication, resulting in serious consequences, including overdose or inadequate treatment of health problems. Visually impaired patients report increased anxiety related to medication management and must rely on others to obtain necessary drug information. Pharmacists have a unique opportunity to pursue accurate medication adherence in this special population. This article reviews literature illustrating how severe medication mismanagement can occur in the visually impaired elderly and presents resources and solutions for pharmacists to take a larger role in adherence management in this population.