Expert: Mary Gordon - 9/14/2009

Question
Hi Mary,

My 88 year old mom has Alzheimers and my 88 year old dad is her primary caregiver. She occasionally gets agitated and very occasionally aggressive with him. The doctor (cardiologist) put her on sertaline (Zoloft generic) some years ago. She is also on Aricept,Fosamax,Lipitor and Synthroid. The cardiologist in late July put her on Haldol for increasing agitation. We noticed a marked negative reaction and so it was phased out. We then took my mom to a neurologist who recommended an increased dose of Aricept; she recommended a geriatrician or psychiatrist for drugs affecting behavioral symptoms. Subsequently, my mom saw a geriatrician who did some blood work and then, after he sees the results, recommended Depakote for the agitation - 250mg twice a day. Is this a reasonable drug for her or will it cause too much sedation or other negative side effects?

Thanks so much,
Janet

Answer
Hi Janet, there is only one way to find out and that is to try the medication. Start with a low dose and see what happens.

As you probably know there are a number of drugs used to deal with agitation and disruptive or aggressive behaviors. These include anxiolytics like Ativan and Serax, newer "atypical" antipsychotics like zyprexa, serquel or risperdal, and older ones like haldol. The antipsychotics are the more common option but sometimes doctors will try an anticonvulsant/mood stabilizer, such as divalproex (Depakote), for hostility or aggression.

The thing is, everyone will react differently, and unfortunately, that means trial and error. It is impossible to predict. Even the zoloft she is on (presumably for depression and anxiety) can cause agitation in some people. Aricept is not normally used to treat agitation - it is used to improve cognitive function. However, there is no evidence it helps with the aggressiveness and anxiety (i.e. recent studies show Aricept as no better than a placebo in that department).

As many as 30% will get drowsy with Depakote - but you won't know till you try. You can always give it a few weeks and if it doesn't help, or it causes more problems than it solves, tell the doctor, and take her off it.  Don't be discouraged if it takes a while to hit the right drug or combination of drugs, and the right doses.

Here is a good article that gives you an overview of the options http://www.aafp.org/afp/20020615/2525.html

It is worth trying whatever the doctor suggests, since the real goal is to keep her as happy and comfortable as possible. It can't be pleasant for her to be upset. Not only is it making her miserable, but it must be really making life a challenge for your poor dad. As I know you fear, his well being is as important as hers, as if he gets worn down, he won't be able to cope with her at home.

Hope this helps.

Mary