**Managing Agitation in Dementia: When Antipsychotics Are Considered**
Agitation is a common and challenging symptom in dementia, often causing distress for both individuals and caregivers. When non-drug approaches aren’t enough, doctors may consider antipsychotic medications—but these come with important risks and benefits to weigh.
—
### **What Are Antipsychotics?**
Antipsychotics are medications originally designed to treat psychiatric conditions like schizophrenia. In dementia care, they’re sometimes used “off-label” (not FDA-approved for this specific use) to manage severe agitation, aggression, or hallucinations. Examples include risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa). In 2023, brexpiprazole (Rexulti) became the first FDA-approved drug specifically for Alzheimer’s-related agitation[5].
—
### **When Are They Used?**
These medications are typically a last resort after other strategies fail. For mild agitation, doctors might recommend antidepressants like citalopram or escitalopram first[5]. Antipsychotics are reserved for cases where behavior becomes dangerous—like physical aggression or extreme distress that risks harm to the person or others[3][4].
—
### **Effectiveness vs. Risks**
– **Pros**: They can reduce severe symptoms quickly, providing short-term relief during crises[1][3].
– **Cons**: Side effects include drowsiness, confusion, weight gain, and a higher risk of falls. Most critically, antipsychotics increase the chance of stroke or even death in older adults with dementia—a warning the FDA has highlighted since 2008[3][5].
—
### **Key Considerations**
1. **Short-Term Use**: Doctors aim to prescribe these drugs at the lowest effective dose for weeks rather than months[1][4].
2. **Alternatives First**: Non-drug approaches—like calming routines, reducing noise triggers, or gentle activities—should always be tried initially[5].
3. **Monitoring**: Caregivers should watch closely for side effects and report changes immediately to healthcare providers[3][4].
—
While antipsychotics can help in critical moments over days or weeks relying on them long-term often causes more harm than good Balancing safety dignity and quality of life remains central when navigating this complex decision alongside medical professionals
