Do Mood Stabilizers Help Reduce Agitation and Aggression in Dementia?

Mood Stabilizer Drugs to Treat Dementia?
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Mood stabilizers are medications designed to even out emotions that are highly variable. For example, a person with extreme highs (mania) and lows (depression) may be diagnosed with bipolar disorder and then be prescribed a mood stabilizing medication to try to calm the fluctuations of their moods and emotions. These drugs have also been prescribed at times to treat the behavioral and psychological symptoms of dementia (BPSD).

These are also sometimes referred to as "challenging behaviors" in dementia.

Are Mood Stabilizers Effective in Dementia?

Several different medications- many of which are anticonvulsants (drugs to reduce seizures)- are classified as mood stabilizers. In general, research has not supported widespread use of mood stabilizers in dementia, although there are other factors that the physician is taking into account when she orders these medications. Over time, additional research may shed more light on the use of these medicines in people with dementia.

Here are some of the more common mood stabilizers, including their effectiveness in treating agitation and aggression in dementia, according to research studies.

  • Lithium (Eskalith, Lithobid):

Lithium is typically prescribed to treat bipolar disorder. Studies generally have not found it to be effective in treating the challenging behaviors in dementia.

  • Valproate:

This anticonvulsant drug, which includes divalproex sodium (Depakote), valproate sodium (Depacon) and valproic acid (Depakene, Stavzor), has been used by some physicians to treat aggression in dementia but overall, its use is not supported by research. Some research has even shown an increased loss of brain volume with the use of divalproex sodium in dementia.

  • Carbamazepine (Tegretol):

This is an anticonvulsant medication that is often prescribed to treat seizures in people with epilepsy. Some research has found that this drug was moderately effective in the treatment of aggression in dementia. However, it is not frequently used because it can have negative side effects, such as interactions with other medications, development of low sodium and decreased white blood cell counts.

  • Oxcarbazepine (Trileptal):

Research has shown that this anticonvulsant medication has generally been ineffective in reducing challenging behaviors related to dementia.

  • Lamotrigine (Lamictal):

Lamotrigene is another drug that is typically ordered to treat seizures in epilepsy. There has been some limited research which showed improvement in agitation in dementia with its use and one study found that administering it along with an antipsychotic medication helped avoid increasing the antipsychotic drugs. The Food and Drug Administration notes that lamotrigene has a small risk of a life-threatening rash that can develop as a side effect.

Antipsychotic medications, which are sometimes categorized as mood stabilizers, are often prescribed to help reduce the difficult behaviors and distressing emotions in dementia. Antipsychotic medications include Abilify (aripiprazole), Clozaril (clozapine), Haldol (haloperidol), Risperdol (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine).

Several studies have been conducted on antipyschotic drugs and their use for BPSD. These medicines have a little more support in research to show that they may help with challenging behaviors in dementia, but they also pose a high risk of complications, and even death, with their use. Due to this risk, there has been a nationwide call from the Center of Medicare and Medicaid to reduce the use of antipsychotic drugs in people with dementia by 30% in 2016.

Antipyschotic medications are more appropriate when the person with dementia is experiencing paranoia, delusions or hallucinations that cause them distress. Antipyschotics should not be used just because someone is restless, anxious, wandering or not sleeping well at night.

Non-Drug Approaches, Not Drugs, as the First Step

Most importantly, non-drug interventions for challenging behaviors in dementia should be attempted before medications are used. While there is no solution that works every time, non-drug approaches have shown some effectiveness in reducing, and responding to, BPSD.

DISCLAIMER

**Please note that the information included on this website and linked to both on and from this site is not medical advice and is for guidance and information only. I have made every effort to report information that is medically accurate and scientifically researched, but this is not a substitute for care and guidance from a physician.**

Sources:

Centers for Medicaid and Medicare Services. National Partnership to Improve Dementia Care exceeds goal to reduce use of antipsychotic medications in nursing homes: CMS announces new goal http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-19.html

Clinical Practice and Epidemiology in Mental Health. 2009; 5: 14.  Anticonvulsants in the treatment of aggression in the demented elderly: an update. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704187/

Dementia and Geriatric Cognitive Disorders. 2009;27(2):155-63. Effect of oxcarbazepine in the treatment of agitation and aggression in severe dementia.http://www.ncbi.nlm.nih.gov/pubmed/19182483

Drugs & Aging. 2012 Aug 1;29(8):627-37. The efficacy and safety of newer anticonvulsants in patients with dementia. http://www.ncbi.nlm.nih.gov/pubmed/22734626

Expert Review of Neurotherapeutics. 2012 Feb;12(2):155-8. Association of chronic divalproex sodium use and brain atrophy in Alzheimer's disease. http://www.ncbi.nlm.nih.gov/pubmed/22288670

Journal of Huazhong University of Science and Technology [Medical Sciences]. October 2010, Volume 30, Issue 5, pp 652-658. A meta-analysis of mood stabilizers for Alzheimer’s disease. http://link.springer.com/article/10.1007%2Fs11596-010-0559-5

The Kaohsiung Journal of Medical Sciences. 2012 Apr;28(4):185-93. Mood stabilizers for the treatment of behavioral and psychological symptoms of dementia: an update review. http://www.ncbi.nlm.nih.gov/pubmed/22453066

Psychogeriatrics. 2015 Mar;15(1):32-7. Clinical efficacy of lamotrigine and changes in the dosages of concomitantly used psychotropic drugs in Alzheimer's disease with behavioural and psychological symptoms of dementia: a preliminary open-label trial. http://www.ncbi.nlm.nih.gov/pubmed/25516380

Santa Clara County Mental Health Department. Medication Practice Guidelines. Mood Stabilizers. June 2014. https://www.sccgov.org/sites/mhd/Providers/PharmacyInformation/MHDGuidelines/Mood%20Stablizers%20Complete%206-2014.pdf

United States National Library of Medicine. Drug Record. Carbamazepine. September 30, 2015. http://livertox.nih.gov/Carbamazepine.htm

United States National Library of Medicine. Lamotrigine. January 13, 2016. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a695007.html

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