SSRIs

While there is no known treatment that can delay progression, environmental and pharmacological interventions can help with the behavioral management. Certain behaviors, especially aggression and extreme disruptiveness, as well as delusions require medication. Patients with FTD show serotoninergic deficits which appears largely related to postsynaptic defects although presynaptic deficits have been reported (Huey et al, 2006). Selective serotonin reuptake inhibitors (SSRIs) have been used with some success (Huey et al, 2007; Lebert et al, 2004; Swartz et al, 1997). SSRIs have been used to treat compulsions, ritualistic behaviors, carbohydrate cravings, anxiety and behavioral symptoms in patients with FTD (Swartz et al, 1997). Another study reported that paroxetine decreased or eradicated repetitive, ritualistic behavioral in a large proportion of patients (Chow & Mendez, 2002). The side effects were tolerable for most patients. Paroxetine compared to piracetam improved behavioral symptoms (Moretti et al, 2003). However, there is one study, albeit using paroxetine at a higher dose (40mg) that showed no improvement in behavioral symptoms and some learning difficulties in the paroxetine group (Deakin et al, 2004). Trazodone, was shown to be effective compared with placebo in controlling behavior in patients with FTD (Lebert et al, 2004).

Patients with SD share many similarities with FTD and so SSRIs can be tried for the compulsive behaviors. SSRIs can be warranted in PNFA because patients with this condition are often very aware of their deficits, so depression and social withdrawal are common. There are, however, no reported studies of antidepressant efficacy in this group.