My Demented Mom blog posts about psychiatric medication:
- Good News, US Senators Seek to Cut Misuse of Antipsychotics
- When There’s Nothing You Can Do You Let Go
- You Can Never Undo the Past
- Information sourced from the Alzheimer’s Association
Medications to treat behavioral symptoms
If non-drug approaches fail after they have been applied consistently, introducing medications may be appropriate when individuals have severe symptoms or have the potential to harm themselves or others. Medications can be effective in some situations, but they must be used carefully and are most effective when combined with non-drug approaches.
Medications should target specific symptoms so their effects can be monitored. In general, it is best to start with a low dose of a single drug. Effective treatment of one core symptom may sometimes help relieve other symptoms. For example, some antidepressants may also help people sleep better. Individuals taking medications for behavioral symptoms must be closely monitored. People with dementia are susceptible to serious side effects, including stroke and an increased risk of death from antipsychotic medications.
Sometimes medications can cause an increase in the symptom being treated. Without careful evaluation, some medical providers will increase rather than decrease the dose, putting the person at greater risk. Risk and potential benefits of a drug should be carefully analyzed for any individual.
When considering use of medications, it is important to understand that no drugs are specifically approved by the U.S. Food and Drug Administration (FDA) to treat behavioral and psychiatric dementia symptoms. Some of the examples discussed here represent “off label” use, a medical practice in which a physician may prescribe a drug for a different purpose than the ones for which it is approved.
Antidepressant medications for low mood and irritability
- citalopram (Celexa®)
- fluoxetine (Prozac®)
- paroxetine (Paxil®)
- sertraline (Zoloft®)
- trazodone (Desyrel®)
Anxiolytics for anxiety, restlessness, verbally disruptive behavior and resistance
- lorazepam (Ativan®)
- oxazepam (Serax®)
Antipsychotic medications for hallucinations, delusions, aggression, hostility and uncooperativeness
- newer “atypical” agents such as aripiprazole (Abilify®); olanzapine (Zyprexa®); quetiapine (Seroquel®); risperidone (Risperdal®); and ziprasidone (Geoden®)
- older first-generation drugs such as haloperidol (Haldol®)
The decision to use an antipsychotic drug needs to be considered with extreme caution. A recent analysis shows that atypical antipsychotics are associated with an increased risk of stroke and death in older adults with dementia. The FDA has asked manufacturers to include a “black box” warning about the risks and a reminder that they are not approved to treat dementia symptoms. The warning states: “Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo.”
The analysis states that while risperidone and olanzapine are useful in reducing aggression and risperidone reduces psychosis, both drugs are associated with severe side effects. Despite some efficacy, these drugs should not be used routinely with dementia patients, unless the person is in severe distress or there is a marked risk of harm.
To maximize the chances of effectiveness, the choice of a particular drug, how long it should be used and when it should be discontinued all need to be carefully tailored to an individual’s symptoms and circumstances. The underlying cause of a person’s dementia may also influence the selection of a drug. For example, it is generally considered inadvisable for individuals with dementia with Lewy bodies (DLB) to take antipsychotic drugs.
Many experts recommend that use of drugs to treat agitation, aggression, hallucinations and delusions in persons with dementia be managed by a physician with experience and interest in this area.
Mom was on Paxil for several years. The most helpful thing we got from Banner Alzheimer’s Institute was the psychiatrist switched her to Celexa. Apparently, Paxil, and many other drugs, even over the counter, deplete acetycholine in the brain, which makes it hard to THINK!!! I saw marked improvement in her cognitive abilities within 2 weeks of switching. After a year and half, unfortunately, she has deteriorated but still not to the point she had been at.
I hope you too are taking Acetycholine (or Acetyl l-carnitine) with alpha lipoic acid to help you not get this awful disease. I take many supplements but these are the main two I’d never drop. Check my blog momsdementia.com where I discuss all the supplements I take after doing lots of research.
I am dramatically opposed to the list of drugs here… having been through multiple episodes with my mom in hospital where the ‘go to’ medicine is Haldol (used to sedate rhinos) and Ativan as a distant second (my mom was catatonic for days after – making the doctors think she was a non-functioning zombie). These drugs may make the patients a bit easier to take for hospital/etc. staff who don’t have time to deal with nuisance behaviour, but their effects on the brain are undesirable. Having had a mother with several life-threatening episodes of bleeding inside the skull, from the considered benign combo of Celexa (anti-depressant) and baby aspirin (stroke preventing), I go back to something my mom said a very long time ago – that it’s better to take nothing. The latest studies show over 30% increase of potentially fatal brain bleeds from the combo of anti-depressants and blood thinners, even those as ‘innocent sounding’ as aspirin. Years of dealing with the medical effects later, I highly recommend to those with senior parents to consider very small doses of medicinal marijuana (the non-hallucinogenic type) in edible to mediate behaviour. For my mother, who has had some difficult behaviour for extended periods of time, it was a true God send. It’s calming and uplifting in a mild kind of way and it doesn’t send her into a catatonic state. She is at a level where she has to get dental care at a special clinic at the hospital, and we give her a little before we go, so they can get what they need to done. It has such an amazing effect the hospital staff has said that more of their patients should take it. Our last visit was to extract a tooth – imagine that with a person who has cognitive deficits and anxiety – she had a short snooze and and woke up to the tooth being gone, and was happy for the rest of the day. Truly amazing stuff – it really works for her.
Whenever I read anything about psychotropic drugs in the “management” of FTD along with their potentially devastating side effects, my opinion (coming from the mind of an FTD ‘owner’) is this: I KNOW that I am becoming a monster, and none of those side effects is worse than my little journey and the trail of damage (in EVERY sense of the word) it is leaving behind. My doctor and the woman I’ve hired as my caregiver both have my mandate…give me everything you’ve got to keep me silent and docile. The worst that can happen is the best outcome for this soul.