Mental health

Conventional and atypical antipsychotics and antidepressant (trazodone) for behavioural and psychological symptoms in people with dementia

Question 3: For behavioural and psychological symptoms in people with dementia, do following drugs, when compared to placebo/comparator, produce benefits/harm in the specified outcomes?
1. Conventional antipsychotics
2. Atypical antipsychotics
3. Antidepressant - trazodone

  • Population: individuals with dementias (cause not specified), Alzheimer’s disease, vascular dementia
  • Interventions:
    • conventional (haloperidol, chlorpromazine and thioridazine)
    • atypical antipsychotic drugs (risperidone, aripiprazole, quetiapine and olanzapine)
    • antidepressant (trazodone)
  • Comparison: placebo
  • Outcomes:
    • Conventional antipsychotics (haloperidol, chlorpromazine and thioridazine)
      • behavioural symptom change
      • agitation
      • aggression
      • psychosis
      • caregiver burden
      • functional Status (activities of daily living)
      • adverse effects (Extrapyramidal symptoms)
      • improving "anxious mood" symptom (thioridazine).
    • Atypical antipsychotics
      • behavioural outcome
      • improving psychosis
      • mortality
      • falls/fractures
      • cerebrovascular adverse events
    • Antidepressant (trazodone)
      • clinical global impression
      • agitation
      • cognitive functioning
      • adverse events (Parkinson gait, akathesia, rigidity).

Recommendation(s)

Thioridazine, chlorpromazine or trazodone should not be used for the treatment of behavioural and psychological symptoms of dementia.
Strength of recommendation: STRONG

Haloperidol and atypical antipsychotics should not be used as first line management for behavioural and psychological symptoms of dementia. Where there is clear and imminent risk of harm with severe and distressing symptoms, the short term use of haloperidol or atypical antipsychotic medications may be considered, preferably with specialist inputs. To the extent possible, informed consent and agreement should be obtained from the person and carer with regard to balance of risk and benefit.
Strength of recommendation: STRONG

Evidence profile

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