Sexual Wellness in Older Adults With Anita Clayton, MD at APA

Anita Clayton, MD, discussed the intersection of sexual health, psychopharmacology, and aging in psychiatric practice. Clayton emphasized that sexual functioning remains an important component of overall wellness in patients of all ages, and argued that psychiatrists should address these concerns more directly with patients.

She noted that many clinicians remain uncomfortable initiating conversations about sexual adverse effects and dysfunction, despite the significant impact these issues can have on quality of life and treatment adherence. As Clayton stated, “a lot of providers are reluctant to talk about it and we’re going to help with that.”

Clayton explained that psychiatric clinicians must be prepared not only to recognize sexual adverse effects associated with psychotropic medications but also to intervene appropriately when patients raise concerns. She stressed that improving mental health outcomes should not come at the expense of sexual well-being and highlighted the importance of helping patients maintain “more satisfying sexual lives with the wellness that they have from other conditions that we’re treating.”

The discussion also focused on prescribing considerations in older adults. Clayton noted that aging alters drug metabolism and increases susceptibility to adverse effects, including dizziness, falls, and medical complications.¹ She recommended that psychiatrists regularly reassess medication dosing and tolerability in older adult populations, particularly in the context of comorbid medical illness and polypharmacy. According to Clayton, lower doses may often improve tolerability while maintaining therapeutic benefit.²

Clayton additionally highlighted emerging developments in antidepressant treatment. She contrasted traditional monoaminergic agents with newer therapies targeting alternative neurobiological systems, including glutamate, GABA, and the hypothalamic-pituitary-adrenal axis. She explained that these innovations may benefit patients who do not respond adequately to conventional antidepressants. Clayton concluded that the expanding range of mechanisms of action represents an important advance for treatment-resistant depression and may allow for more individualized psychiatric care.

Dr Clayton is chair of psychiatry and neurobehavioral sciences and professor of clinical obstetrics and gynecology at the University of Virginia. She is also current president of the American Society for Clinical Psychopharmacology.

References

1. Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41(2):67-76.

2. Caffrey AR, Borrelli EP. The art and science of drug titration. Ther Adv Drug Saf. 2021;11:2042098620958910.