Table 2.

Pharmacotherapeutic options for behavioral and psychological symptoms of dementia

Presentation	Suggested medication options and usual effective dose range for each
Depression	• Citalopram, 10–20 mg/day • Sertraline, 25–100 mg/day
Anxiety	• Buspirone, 15–60 mg/day • Trazodone, 50–100 mg/day
Psychosis	• Aripiprazole, 2.5–12.5 mg/day • Olanzapine, 2.5–10 mg/day • Quetiapine, 12.5–100 mg/day • Risperidone, 0.25–3 mg/day
Refractory agitation or presence of mania	• Carbamazepine, 300–600 mg/day • Divalproex sodium, 500–1500 mg/day • Lithium, 150–1000 mg/day • Olanzapine, 2.5–5 mg/day, intramuscular injection
Sleep disturbances	• Trazodone, 25–50 mg/day • Eszopiclone, 1 mg/day • Melatonin, 1.5–6 mg/day • Zaleplon, 5 mg/day • Zolpidem, 5 mg/day • Ramelteon, 8 mg/day within 30 min of bedtime
Sexual disinhibition	The following medications should be added after use of a SSRI, second-generation anti-psychotic or divalproex: • Estrogen 0.625–1.25 mg/day • Medroxyprogesterone 100 mg/week intramuscular injection • Leuprolide acetate 7.5 mg/month intramuscular injection
Pain	• Acetaminophen 3000 mg/day max in frail older adults • Gabapentin 300–3600 mg/day, consider 100–900 mg/day if poor renal function • SNRIs  - Desvenlafaxine 25–50 mg/day  - Duloxetine 20–60 mg/day • Opioids for moderate to severe pain

All cases assume that the patient is on a cholinesterase inhibitor (e.g., donepezil) at maximum tolerated dosage and that the addition of memantine has been considered for moderate to severe dementia. Before adding additional medications, be sure that current medication regimen is optimized, and medication discontinuation has been considered for medications with limited or no benefit

SSRI selective serotonin reuptake inhibitor, SNRI serotonin and norepinephrine reuptake inhibitor