Psychiatric/Psychotropic Medication

Anticonvulsant medication

These medicines are used to treat a number of disorders including epilepsy, illness (depression) and aggression for example, Carbamazepine (Tegretol).

Antidepressant medication

These medicines are used to alleviate the symptoms of depression (low mood, loss of weight and appetite or difficulty sleeping: Mirtazapine (Zispin), Citalopram (Cipralex) and Lorazepam (Ativan).

Hypnotics (sleeping tablets)

These medicines are sleeping tablets for people who have difficulty sleeping to the extent that it is causing them distress: Zopiclone (Zimovane).

Antipsychotic medication

These medicines are used to treat particular types of beliefs (delusions) or perceptions (hallucinations) that other people do not perceive. They are occasionally used for people who are distressed by severe agitation. They are sometimes referred to as ‘Typical’ – the older drugs for example Haloperidol (Serenace) and ‘Atypical’ – the newer drugs for example, Risperidone (Risperdal).

For further information refer to the British Medical Association’s Guide to Medicines and Drugs or speak to your GP or practice nurse.

10-30% of people with dementia have psychotic symptoms (see things that are not there, or believe others are against them etc) during the course of the dementia. 

30-50% will show distress by being agitated, calling out, expressing aggression or pacing around etc. All of these symptoms can at times be distressing for people. Anti-psychotic drugs are licensed for the treatment of psychosis but not for behavioural complications of dementia.

There are risks with all medicines but it is important that you know that some of the newer anti-psychotic drugs cause an increase in stroke disease in people with dementia.  For every 50 people treated with Risperidone (Risperdol) or Olanzapine (Zyprexa) one extra person will have a stroke. People who take these drugs are up to twice as likely to die as those who do not. More recent data suggests that the risk of stroke is similar for all older ‘typical’ types of anti-psychotic medication as well. The frequency of stroke in those with dementia receiving anti-psychotic medication is about one out of every 40 people who take this medication for a year.

Some people with dementia who showed evidence of psychosis earlier on in their illness continue to respond to anti-psychotic medication later on in the illness. There is also evidence that anti-psychotics can reduce agitation and apparent distress in people with dementia. For some people they seem effective, others feel that their loved ones become less well on these drugs and that they seem to do harm. However, when distress is severe, many carers feel that relieving the distress is even more important than avoiding medicines that can do some harm.

Remember, that only anti-psychotics will alleviate behaviours driven by psychosis. The drugs are licensed for this purpose, although the risks of stroke will still occur.

Medication options are set out in the table. As you can see, there are problems with all options. Using no medicine is always preferable, but sometimes medication alleviates people’s distress.

Newer ‘Atypical’ anti-psychotic medicines

Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel)

  • Increased rate of stroke and death
  • Effective reduction in psychosis arising in dementia
  • Evidence of reduction in agitation and distress
  • Fewer side effects such as stiffness and tremor
  • Often better tolerated
  • Not recommended for use by UK medicines regulatory authority

Older ‘Typical’ anti-psychotic medicines

Haloperidol (Serenace), Trifluoperazine (Stelazine)

  • Risk of stroke likely to be the same as with newer antipsychotics
  • Risk of death may be higher than with newer anti-psychotic medicines due to side effects of stiffness, shaking and poor mobility
  • Falls and immobility
  • Heart problems including cardiac arrest

Not using medicines

  • No side effects
  • Risk of continued agitation and severe torment
  • Falls, wandering and injury as a result of withholding treatments
  • May even hasten death as a result
  • Increased carer stress may mean that person with dementia can no longer live at home or in a preferred alternative setting

Other medicines

  • Many other drugs have been used but there is less evidence that they work. Many side effects and can also harm
  • Will not normally effectively treat psychosis in dementia
  • Some evidence for use of anti-dementia drugs in behaviour disturbance: drugs not licensed or approved by the National Institute for Health and Care Excellence (NICE) for these purposes

While we are aware that these medicines may cause difficulties, the intention is to reduce suffering for the person, and to help carers cope better for longer. This should make for a better quality of life over the coming weeks, months or years.