Can Mood Stabilizers Help With Agitation in Dementia?

Mood stabilizers are medications designed to even out emotions that are highly variable. For example, a person with extreme highs (mania) and lows (depression) may be diagnosed with bipolar disorder and then be prescribed a mood-stabilizing medication to try to calm the fluctuations of their moods and emotions. These drugs have also been prescribed at times to treat the behavioral and psychological symptoms of dementia (BPSD). These are also sometimes referred to as "challenging behaviors" in dementia.

Mood Stabilizer Drugs to Treat Dementia?
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Are Mood Stabilizers Effective?

Unfortunately, the short answer is no—mood stabilizers have not been found effective for treating dementia, and some may even cause harm.

Several different medications—many of which are anticonvulsants (drugs to reduce seizures)—are classified as mood stabilizers. In general, research has not supported widespread use of mood stabilizers in dementia, although there are other factors that the physician is taking into account when she orders these medications. Over time, additional research may shed more light on whether the use of these medicines is appropriate in people living with dementia.

Here are some of the more common mood stabilizers, including the extent of their effectiveness in treating agitation and aggression in dementia, according to research studies.

Lithium (Lithobid)

Lithium is typically prescribed to treat bipolar disorder. Studies generally have not found it to be effective in treating the challenging behaviors in dementia.

Valproate (Depakote)

This anticonvulsant drug group, which includes divalproex sodium (Depakote), valproate sodium, and valproic acid (both available as generics), has been used by some physicians to treat aggression in dementia but overall, its use is not supported by research. Some research has even shown an increased loss of brain volume with the use of divalproex sodium in dementia. A study of divalproex sodium to prevent agitation and psychosis in people with Alzheimer’s disease found not only that it was not effective, but it was associated with drowsiness and gait changes, which can raise the risk of falls.

Carbamazepine (Tegretol)

This is an anticonvulsant medication that is often prescribed to treat seizures in people with epilepsy. Some research has found that this drug was moderately effective in the treatment of aggression in dementia. However, it is not frequently used because it can have negative side effects, such as interactions with other medications, development of low sodium and decreased white blood cell counts.

Oxcarbazepine (Trileptal)

Research has shown that this anticonvulsant medication has generally been ineffective in reducing challenging behaviors related to dementia.

Lamotrigine (Lamictal)

Lamotrigine is another drug that is typically ordered to treat seizures in epilepsy. There has been some limited research which showed improvement in agitation in dementia with its use, and one study found that administering it along with an antipsychotic medication helped avoid increasing the antipsychotic drugs. The Food and Drug Administration notes that lamotrigine has a small risk of a life-threatening rash that can develop as a side effect.

Antipsychotic Medications

Antipsychotic medications, which are sometimes categorized as mood stabilizers, are often prescribed to help reduce the difficult behaviors and distressing emotions in dementia. Antipsychotic medications include Abilify (aripiprazole), Clozaril (clozapine), Haldol (haloperidol), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine).

Several studies have been conducted on antipsychotic drugs and their use for BPSD. These medicines have a little more support in research to show that they may help with challenging behaviors in dementia, but they also pose a high risk of complications, and even death, with their use. Due to this risk, there has been a nationwide call from the Centers for Medicare and Medicaid Services (CMS) to reduce the use of antipsychotic drugs in people with dementia.

Antipsychotic medications are more appropriate when the person with dementia is experiencing paranoia, delusions or hallucinations that cause them distress. Antipsychotics should not be used just because someone is restless, anxious, wandering, or not sleeping well at night.

The National Partnership to Improve Dementia Care in Nursing Homes—which includes state and federal agencies, care providers, and advocacy groups—has helped to reduce the use of antipsychotic medications in nursing homes by more than 40% since 2012.

A Word from Verywell

Most importantly, non-drug interventions for challenging behaviors in dementia should be attempted before medications are used. While there is no solution that works every time, non-drug approaches have shown some effectiveness in reducing and responding to, BPSD.

19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. National Library of Medicine, DailyMed. LITHOBID- lithium carbonate tablet, film coated, extended release [drug label].

  2. Yeh Y-C, Ouyang W-C. Mood stabilizers for the treatment of behavioral and psychological symptoms of dementia: An update review. Kaohsiung J Med Sci. 2012;28(4):185-193.

  3. U.S. National Library of Medicine, DailyMed. DEPAKOTE- divalproex sodium tablet, delayed release [drug label].

  4. Fleisher AS, Truran D, Mai JT, et al. Chronic divalproex sodium use and brain atrophy in Alzheimer disease. Neurology. 2011;77(13):1263-1271. doi:10.1212/WNL.0b013e318230a16c

  5. Tariot PN, Schneider LS, Cummings J, et al. Chronic divalproex sodium to attenuate agitation and clinical progression of Alzheimer disease. Arch Gen Psychiatry. 2011;68(8):853. doi:10.1001/archgenpsychiatry.2011.72

  6. U.S. National Library of Medicine, DailyMed. TEGRETOL- carbamazepine tablet [drug label].

  7. Kaeley N, Kabi A, Bhatia R, Mohanty A. Carbamazepine-induced hyponatremia – A wakeup call. J Family Med Prim Care. 2019;8(5):1786. doi:10.4103/jfmpc.jfmpc_185_19

  8. U.S. National Library of Medicine, DailyMed. TRILEPTAL- oxcarbazepine tablet, film coated [drug label].

  9. U.S. National Library of Medicine, DailyMed. LAMICTAL- lamotrigine tablet [drug label].

  10. Suzuki H, Gen K. Clinical efficacy of lamotrigine and changes in the dosages of concomitantly used psychotropic drugs in Alzheimer’s disease with behavioural and psychological symptoms of dementia: a preliminary open-label trial: efficacy of lamotrigine in BPSD. Psychogeriatrics. 2015;15(1):32-37. doi:10.1111/psyg.12085

  11. U.S. National Library of Medicine, DailyMed. ABILIFY- aripiprazole tablet [drug label].

  12. U.S. National Library of Medicine, DailyMed. CLOZARIL- clozapine tablet [drug label].

  13. U.S. National Library of Medicine, DailyMed. HALDOL- haloperidol injection [drug label].

  14. U.S. National Library of Medicine, DailyMed. RISPERDAL- risperidone tablet [drug label].

  15. U.S. National Library of Medicine, DailyMed. SEROQUEL- quetiapine tablet, film coated [drug label].

  16. U.S. National Library of Medicine, DailyMed. ZYPREXA- olanzapine tablet [drug label].

  17. Centers for Medicare & Medicaid Services. National Partnership to Improve Dementia Care in Nursing Homes.

  18. Mountain-Pacific Quality Health. Antipsychotic medicines for people with dementia.

  19. Crystal S, Jarrín OF, Rosenthal M, Hermida R, Angell B. National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes. Innov Aging. 2020;4(3):igaa018. doi:10.1093/geroni/igaa018

Additional Reading

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.