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Antipsychotics, Antidepressants, Anticonvulsants, Melatonin, and Benzodiazepines for Behavioral and Psychological Symptoms of Dementia: a Systematic Review of Meta-analyses

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The purpose of this systematic review is to evaluate the data on the use of antipsychotics, antidepressants, anticonvulsants, melatonin, and benzodiazepines for the treatment of behavioral and psychological symptoms of dementia (BPSD) from meta-analyses. We performed a literature search of PubMed, MEDLINE, EMBASE, PsycINFO, and Cochrane collaboration databases through August 31, 2016 using the following keywords: dementia, meta-analysis, antipsychotics, antidepressants, anticonvulsants, melatonin, and benzodiazepines. We found a total of 24 meta-analyses that assessed the use of antipsychotics, antidepressants, anticonvulsants, melatonin, and benzodiazepines among individuals with dementia. Sixteen of these meta-analyses evaluated the use of antipsychotics among individuals with dementia. One of the 16 meta-analyses not only evaluated the use of antipsychotics but also antidepressants and mood stabilizers for BPSD. A total of three meta-analyses assessed the use of antidepressants among individuals with dementia, two meta-analyses evaluated the use of mood stabilizers, two meta-analyses evaluated the use of melatonin, and one meta-analysis evaluated the use of melatonin, trazodone, and ramelteon for sleep disturbances among individuals with dementia. There was no meta-analysis for the use of benzodiazepines among individuals with dementia. Data from this systematic review indicates that antipsychotics demonstrate modest efficacy in the treatment of BPSD. Antidepressants appear to improve symptoms of depression among individuals with dementia and may improve some behavioral symptoms among these individuals. Anticonvulsants appear to have no beneficial effects when used in individuals with dementia. Melatonin appears to improve some sleep parameters and some behavioral symptoms among these individuals. Trazodone appears to improve some sleep parameters among individuals with dementia but has not demonstrated efficacy in managing BPSD. The use of antipsychotics and anticonvulsants in this population is limited by their adverse effect profile.

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Authors and Affiliations

  1. Department of Psychiatry, MetroHealth, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Rajesh R. Tampi MD, MS, DFAPA & Silpa Balachandran MD

  2. Saint Francis Hospital and Medical Center, Hartford, CT, USA

    Deena J. Tampi MSN, MBA-HCA, RN

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  1. Rajesh R. Tampi MD, MS, DFAPA
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  2. Deena J. Tampi MSN, MBA-HCA, RN
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  3. Silpa Balachandran MD
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Correspondence to Rajesh R. Tampi MD, MS, DFAPA.

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Rajesh R. Tampi declares that he has no conflict of interest. Deena J. Tampi declares that she has no conflict of interest. Silpa Balachandran declares that she has no conflict of interest.

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This article is part of the Topical Collection on Geriatric Disorders

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Tampi, R.R., Tampi, D.J. & Balachandran, S. Antipsychotics, Antidepressants, Anticonvulsants, Melatonin, and Benzodiazepines for Behavioral and Psychological Symptoms of Dementia: a Systematic Review of Meta-analyses. Curr Treat Options Psych 4, 55–79 (2017). https://doi.org/10.1007/s40501-017-0104-2

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