Can Mood Stabilizers Help With Agitation in Dementia?

Medically reviewed by Nicholas R. Metrus, MD

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?

Unfortunately, the short answer is no—mood stabilizers have not been found effective for treating dementia, and some may even cause harm.

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 whether the use of these medicines is appropriate in people living with dementia.

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

Lithium (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 (Depakote)

This anticonvulsant drug group, which includes divalproex sodium (Depakote), valproate sodium, and valproic acid (both available as generics), 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. A study of divalproex sodium to prevent agitation and psychosis in people with Alzheimer’s disease found not only that it was not effective, but it was associated with drowsiness and gait changes, which can raise the risk of falls.

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)

Lamotrigine 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 (FDA) notes that lamotrigine has a small risk of a life-threatening rash that can develop as a side effect.

Antipsychotic Medications

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), Rexulti (brexpiprazole), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine).

Several studies have been conducted on antipsychotic 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 Centers for Medicare and Medicaid Services (CMS) to reduce the use of antipsychotic drugs in people with dementia.

Takeaway

In 2023, the FDA approved Rexulti (brexpiprazole) for the treatment of agitation symptoms associated with dementia due to Alzheimer's disease. Rexulti is the first and only FDA-approved drug for this indication and carries a Boxed Warning due to an increased risk of death in elderly patients.

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

The National Partnership to Improve Dementia Care in Nursing Homes—which includes state and federal agencies, care providers, and advocacy groups—has helped to reduce the use of antipsychotic medications in nursing homes by more than 40% since 2012.

A Word from Verywell

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.

Read the original article on Verywell Health.