Several medications, including lorazepam and oxazepam, can help treat anxiety in people with dementia. These drugs are examples of benzodiazepines. A person should take the medications as a doctor prescribes and speak with a healthcare professional if they experience any adverse effects.
Although many doctors prescribe antidepressants as a first-line treatment, guidelines do not suggest the routine treatment of depression and anxiety with antidepressants in people living with dementia.
Anxiety among older adults is a common health concern, but there are medications that may help to ease the symptoms. These can include duloxetine, escitalopram, buspirone, venlafaxine, and sertraline.
It may be useful for behavioural disturbances in dementia including agitation, but evidence from randomized controlled trials is lacking, thus, buspirone is not recommended as a first- or second-line medication. Furthermore, no studies have addressed the role of buspirone in combination with other agents.
Antidepressants. Antidepressants such as sertraline, citalopram, mirtazapine and trazodone are widely prescribed for people with dementia who develop changes in mood and behaviour.
But common ones that can ease agitation include: Medicines that treat paranoia and confusion, called neuroleptics or antipsychotics. Examples of these are aripiprazole (Abilify), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).
Try gentle touching, soothing music, reading, or walks. Reduce noise, clutter, or the number of people in the room. Try to distract the person with a favorite snack, object, or activity. Limit the amount of caffeine the person drinks and eats.
Possible causes
Every person living with dementia reacts to circumstances in their own way. Sometimes anxious behaviours may be related to changes in the brain. Or there may be something in the environment that triggers the behaviour. At other times, a task may be too complex, or the person may not be feeling well.
Another 41% of the people in the three-or-more medication group were taking a benzodiazepine, such as lorazepam (Ativan), often used for anxiety or agitation in people with dementia.
The most prominent of anti-anxiety drugs for the purpose of immediate relief are those known as benzodiazepines; among them are alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan).
SSRIs and SNRIs are often the first-line treatment for anxiety. Common SSRI brands are Celexa, Lexapro, Luvox, Paxil, and Zoloft. Common SNRI brands are Pristiq, Cymbalta, and Effexor XR. Pros: They are effective for a lot of people and they have a solid safety profile.
Clinicians usually avoid prescribing benzodiazepines for older people with dementia because these drugs are associated with well-documented harms, including fall-related injuries such as fractures.
Narcotics such as hydrocodone, oxycodone and morphine; muscle relaxants such as cyclobenzaprine, carisoprodol; NSAIDs such as ibuprofen, naproxen should be avoided if possible. If these medications must be used, they should be used at the lowest effective dose for the shortest duration to minimize adverse effects.
Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. Many antipsychotics are used "off label" to treat agitation and other related behaviors.
Anxiety often occurs early in the course of AD, especially among patients with MCI, mild dementia, or early-onset forms of the disease, and can promote progression and conversion from MCI to dementia.
Try to identify activities that are soothing to the person, such as listening to calming music, looking at photographs or watching a favorite movie. Take a walk with the person to help reduce their restlessness. Talk to the person's doctor about the best times of day for taking medication.
Benzodiazepines.
So these drugs are used for anxiety, for panic attacks, for sedation, and to treat insomnia. They can easily become habit-forming. Commonly used drugs: In older adults, these include: Lorazepam (brand name Ativan)
Five behaviors significantly improved for patients who responded: delusions, agitation, anxiety, disinhibition, and irritability. Patients with these symptoms are more likely to respond to treatment with donepezil.
The cholinesterase inhibitors most commonly prescribed are: Donepezil (Aricept®): approved to treat all stages of Alzheimer's disease. Rivastigmine (Exelon®): approved for mild-to-moderate Alzheimer's as well as mild-to-moderate dementia associated with Parkinson's disease.
Five studies reported accelerated cognitive deterioration in association with benzodiazepine use. Two studies reported clinical efficacy for lorazepam and alprazolam to reduce agitation in Alzheimer's disease patients. No evidence was found for an improvement of sleep quality using benzodiazepines.
This medicine should not be used to treat behavioral problems in older adult patients who have dementia or Alzheimer disease. Quetiapine is an antipsychotic medicine that works in the brain.