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Given the growing numbers of older people with mental illnesses, it seems obvious that more resources should be put into research on geriatric psychopharmacology. This becomes evenmore necessary because of the already existing wide gaps in the literature on psychopharmacology in younger versus older adults. Most randomized controlled trials (RCTs) of psychotropic medications, except for those to be used in neurocognitive disorders like Alzheimer’s disease, conducted by the pharmaceutical industry for approval by the USA Food and Drug Administration (FDA), are typically restricted to adults under the age of 65 years. Yet, when a drug is approved by the FDA, it is commonly used in older adults in daily clinical practice, irrespective of the fact that such use should be considered “off-label” because of a lack of empirical evidence on its utility and dosage in that age group. Indeed, there are unique pharmacokinetic and pharmacodynamic issues suggesting that older adults have differential sensitivity and a greater risk of a number of side effects with these medications when administered at the FDA-approved standard dosages. Yet, few systematic trials are conducted in older populations to determine optimal dosages. Similarly, although many of these drugs are used clinically over a long time period, there is a dearth of prolonged longitudinal studies of these drugs in older adults. Thus, there is limited evidence-based knowledge about the efficacy and safety of many psychotropic drugs, which have not been formally assessed and approved for use in older patients. This issue of the International Psychogeriatrics presents three papers on the use of specific psychotropic medications – i.e. clozapine in primary psychotic and bipolar disorders, anticonvulsants in the prevention and/or treatment of delirium, and mirtazapine for agitated behavior in patients with dementia. Two other papers focus on the impact of standardizing care for agitation in dementia using an integrated care pathway on an inpatient geriatric psychiatry unit and a qualitative study of the perspectives of residents of long-term care facilities on shared decision making in medication management. Renzenbrink and Wand (2022) reviewed seven primarily observational studies including a total of 128 patients aged 65–86 years, treated with clozapine. Most (87%) of these patients had schizophrenia which was either treatment refractory or treatment intolerant. The sample was predominantly male (94%) and White (87%). In view of the demographic homogeneity of the sample, the authors are cautious in their clinical recommendations for diverse groups of older patients with psychotic or bipolar disorders. While agranulocytosis was less of an issue in this population, other toxicities were of a greater concern – e.g. anticholinergic side effects, delirium, seizures, and orthostatic hypotension. As the population ages, there will bemore patients with schizophrenia in the geriatric age group, and a proportion of themwill be treatment refractory to firstand secondline therapy, and thus could be candidates for clozapine trials. Therefore, more detailed studies of the patient experience with clozapine in the geriatric age range are clearly warranted. There are currently no evidence-based effective pharmacological treatments for managing delirium, particularly hyperactive delirium with psychosis and severe agitation. Anticonvulsants are used clinically to manage delirium, based on observational studies in adults across the lifespan suggesting some benefit with the use of valproic acid. However, it is necessary to examine the data specifically in older patients who are at a considerably higher risk of delirium than younger adults. Gupta et al. (2022) conducted a systematic review of RCTs of anticonvulsants to prevent or treat delirium in geriatric population. They identified only four RCTs, all involving gabapentinoids (pregabalin or gabapentin) in patients undergoing orthopedic or spinal surgeries. The authors conclude that there is no high-quality evidence supporting the use of anticonvulsants in preventing or treating delirium in hospitalized older adults. Fortunately, several initiatives are currently underway to standardize delirium research (Bingham and Flint, 2022). Some multicomponent prevention studies have suggested useful strategies for delirium management. Hopefully, high quality, interdisciplinary, and collaborative research will lead to development and use of better treatment options for older patients with delirium. Severe agitation is an extremely common problem in older patients with dementia. There is an unquestionable need for safe and proven pharmacological treatments for persons who do not respond International Psychogeriatrics (2022), 34:10, 853–855 © International Psychogeriatric Association 2022