Medications: Anti-Psychotics (Neuroleptics)

IMPORTANT! This information is meant to be used only for general information, in accordance with current medical information and the practice experience of this geriatrician and should never be used alone, outside of the medical advice of one’s personal physician.

All anti-psychotics may increase the absolute risk for stroke by approximately 3 percent. They may increase the risk of sudden death by 1 percent. They should not be used for garden-variety agitation. Several antidepressants—Citalopram®, Remeron® or Zoloft®—make much better choices in cases of anxiety or aggression.

However, if a patient is paranoid, delusional or hallucinating and has extreme anxiety brought on by these delusions, anti-psychotics can be very helpful. First, delirium, infection, new medications need to be ruled out. In rare cases, ischemia, decreased blood flow, may be the issue. Each medication has a different effect. If one fails, another may work. However, all can affect walking and lead to further decline. I try to use the minimum amount necessary for the shortest time possible, to allow safe care.

  • Risperdone/Risperdal® can help decrease paranoia and delusions. However, it may also sedate a patient,, or cause restlessness; “akathisia.” Because it may cause stiffening or trouble walking, patients with Parkinson’s disease should avoid it because they are much more at risk for these complications. In some cases, it has been associated with “extrapyramidal symptoms,” strange movements of the mouth, or body.
  • Haloperidol/Haldol®, an older medication, may alleviate delusions, hallucinations and paranoia. It is more likely to cause strange movements, restlessness, walking problems and general stiffness then the other newer medications and should be avoided by Parkinson’s patients with. This drug stays in body fat for some time. Therefore, its effects may linger for days after the drug is discontinued.
  • Aripiprazol/Abilify® cuts down on hallucinations and agitation without sedating patients as much as some other medications. But because of the way the drugs works, some patients may actually experience more agitation.
  • Ziprasidone/Geodon® may also be used to treat hallucination and delusion. Some report that it may not be as effective as the other anti-psychotics above.
  • Quetiapine/Seroquel® helps moderate paranoia, delusions and hallucinations. It is less likely to cause side effects like involuntary movements or stiffness. Because of this, it remains a good option for those suffering from Parkinson’s or Lewy Body dementia. Side effects can include sedation and lowered blood pressure. Some patients do not tolerate this medication.
  • Olanzpine/Zyprexa® may also treat paranoia and delusions. However it can also increase blood glucoseor lipids. However, it may be helpful when Risperdal® and Seroquel® have not worked.