4. Drug treatments - general information
The non-drug approaches described above should be tried before drugs are used, unless a person’s symptoms are very bad and are causing them severe distress or risk of physical harm. If they are, it may be a good idea to prescribe medication immediately, once any medical cause for the behaviour (such as pain or infection) has been ruled out. Even then, drugs must be used as well as, and not instead of, non-drug approaches.
All medicines have at least two names: a generic name, which identifies the substance, and a proprietary (trade) name, which may vary depending upon the company that makes it. For example, Risperdal is a trade name for the antipsychotic drug risperidone. This factsheet uses generic names.
The doctor should discuss with the person and/or their carer what symptom or symptoms they are prescribing a drug for, and they should then monitor how it is working. Don’t expect immediate results in people taking drugs for behavioural and psychological symptoms. Any benefits may take several weeks to appear. Drugs may also stop working. This is because dementia is a degenerative condition, meaning that the chemistry and structure of the brain will change during the course of the illness.
All drugs have side effects which are usually related to dose, so the doctor will often begin by prescribing a small dose and then gradually increase this until the best balance of benefits and side effects is achieved. This approach is sometimes known as ‘start low and go slow’.
Once treatment has begun it is important that it is regularly reviewed by a doctor, often the person’s GP. For antipsychotic drugs (see below), this review should be after six or 12 weeks, or both.
Drugs should always be taken as prescribed by the doctor and be kept safe and secure. They can be dangerous if accidently taken in large quantities. A pharmacist should be able to advise on storing and taking drugs, including ways to help someone remember to take them at the right times. For example, they might recommend a ‘dosette’ box which has compartments for different days and times. This helps to prevent someone forgetting and accidentally taking more than the recommended dose.