Drug Safety

, Volume 40, Issue 8, pp 647–649 | Cite as

Good Intentions, But What About Unintended Consequences?

  • Helen C. KalesEmail author
  • Donovan T. Maust

The greatest thing that science teaches you is the law of unintended consequences.

- Ann Druyan

Managing the behavioral and psychological symptoms of dementia (BPSD) that accompany cognitive decline—including agitation, anxiety, depression, aggression, sleep problems, and socially inappropriate behaviors—is one of the biggest challenges of day-to-day care. These symptoms are associated with many of the negative outcomes of dementia, including hospitalizations; increased placement in nursing homes; caregiver stress, including depression and lost income; and decreased quality of life for both patient and caregiver. Despite the fact that, in the USA, no drugs have been approved by the US FDA for BPSD, the current mainstay of treatment is the (primarily off-label) use of psychotropic medications [1, 2]. Of the agents used to treat BPSD, atypical antipsychotics have the strongest evidence base, although their benefits are moderate at best (effect size 0.13–0.16) [3]. Any such benefits must...


Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this commentary.

Conflicts of interest

Helen Kales and Donovan Maust have no conflicts of interest that are directly relevant to this commentary.


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Copyright information

© Springer International Publishing AG (outside the USA) 2017

Authors and Affiliations

  1. 1.Program for Positive Aging, Department of PsychiatryUniversity of MichiganAnn ArborUSA
  2. 2.Department of Veterans AffairsHSR&D Center for Clinical Management Research (CCMR)Ann ArborUSA
  3. 3.Geriatric Research, Education and Clinical Center (GRECC)VA Ann Arbor Healthcare SystemAnn ArborUSA

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