From the Guidelines
For patients with dementia, selective serotonin reuptake inhibitors (SSRIs) such as citalopram (10-20mg daily) or sertraline (25-100mg daily) are the most effective medications for calming symptoms, particularly for depression and anxiety, due to their minimal anticholinergic side effects and effectiveness as reported in 1.
Medication Options
When considering medication for calming symptoms in dementia patients, it's essential to prioritize those with the fewest side effects.
- SSRIs like citalopram and sertraline are preferred for their efficacy and safety profile, as noted in 1.
- Cholinesterase inhibitors, such as donepezil, may also be beneficial for some patients, not just for slowing cognitive decline but potentially for reducing behavioral symptoms, as suggested by 1.
- However, the use of antipsychotics should be approached with caution due to the increased risk of stroke and mortality, and they should be prescribed at the lowest effective dose for the shortest duration possible.
Non-Pharmacological Approaches
Before initiating medication, non-pharmacological strategies should always be attempted, including:
- Identifying and addressing triggers for agitation or anxiety
- Maintaining routines and creating a calm environment
- Using reassurance techniques These approaches can significantly reduce the need for pharmacological interventions and improve the patient's quality of life.
Considerations for Medication Use
Any medication started for calming symptoms in dementia patients should be initiated at a low dose and gradually increased while closely monitoring for side effects. Regular reassessment of the medication's effectiveness and the patient's condition is crucial to determine if continued treatment is necessary, as emphasized in 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Effective Medications for Calming Symptoms in Patients with Dementia
The following medications have been studied for their effectiveness in calming symptoms in patients with dementia:
- Atypical antipsychotics, such as risperidone and olanzapine, have shown modest, statistically significant efficacy in treating neuropsychiatric symptoms of dementia, although they are associated with an increased risk of stroke 2, 3, 4
- Cholinesterase inhibitors have shown small, although statistically significant, efficacy in treating neuropsychiatric symptoms of dementia 2
- Antidementia drugs, such as galantamine, donepezil, rivastigmine, and memantine, have been shown to be effective in treating behavioral disorders in dementia 3
- Anticonvulsants, such as carbamazepine, oxcarbazepine, and topiramate, have limited evidence for their effectiveness in treating behavioral and psychological symptoms of dementia, and may be associated with adverse effects 5
- Selective serotonin reuptake inhibitors, such as citalopram, may be effective in treating depression in patients with dementia 3
Comparison of Medications
Studies have compared the efficacy of different medications in treating neuropsychiatric symptoms of dementia:
- A systematic review found that atypical antipsychotics, such as risperidone and olanzapine, have the best evidence for efficacy in treating neuropsychiatric symptoms of dementia, although the effects are modest and complicated by an increased risk of stroke 2
- A review of anticonvulsants found that they are unlikely to be effective in treating behavioral and psychological symptoms of dementia, although the quality of existing evidence is low 5
- A study found that risperidone is effective in treating agitation, aggression, and psychosis in patients with dementia, although it is associated with an increased risk of cerebrovascular adverse events and death 4
Safety Concerns
Medications used to treat neuropsychiatric symptoms of dementia can have safety concerns: