Antipsychotics in dementia: Best Practice Guide
Treatment of comorbid conditions in patients with dementia.
In the treatment of comorbid conditions in people with dementia, the potential for drug interactions, adverse reactions and aggravation of the underlying condition must be considered. For example if a person on an antipsychotic for BPSD requires an opioid analgesic there will be an increased risk of sedation, dizziness and falls.
Symptoms of depression and anxiety are common in people with dementia and are sometimes difficult to distinguish. Clinical depression or anxiety requires treatment but drug selection requires careful consideration of possible adverse effects and drug interactions. Most antidepressants are effective for depressive and anxiety disorders, and choice should be based on safety profile as there is little evidence of the effectiveness of individual agents in people with dementia.
An SSRI (e.g. citalopram, paroxetine or fluoxetine) is preferred as they have less troublesome anticholinergic side effects (urinary retention, constipation, delirium) than tricyclic antidepressants such as amitriptyline or nortriptyline. The latter can also cause postural hypotension and sedation which may increase the risk of falls.
It should be noted that all antidepressants can cause hyponatraemia, especially in the elderly ,and it is advisable to check the serum sodium periodically during the first few months of treatment. Increasing confusion is a common symptom of hyponatraemia in the elderly and diuretics may increase the risk.
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