Medications for behavioral symptoms
Medications for behavioral symptoms should be started at a low dose and then increased slowly based on the patient’s response and the presence of side effects. It is only fair to note that very few clinical studies exist examining the benefits of the following medications, and the following information is base primarily on clinical experience.
Antidepressants
While originally created to treat depression, certain antidepressants are effective in treating anxiety disorders, preventing panic attacks and obsessive compulsive behavior. One group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be useful in reducing the aggressive impulses, poor impulse control and carbohydrate craving associated with early Pick’s/FTD. People with FTD usually do not experience many side effects with SSRIs, and they are generally considered the best available medications for controlling problematic behaviors.
Examples of SSRIs include:
- fluoxetine (Prozac®)
- sertraline (Zoloft®)
- paroxetine (Paxil®)
- fluvoxamine (Luvox®)
- citalopram (Celexa®)
- escitalopram (Lexapro®)
Other antidepressants (not SSRIs) that may be useful:
- trazodone (Desyrel®)
- venlafaxine (Effexor®)
- duloxetine (Cymbalta®)
- bupropion (Wellbutrin®)
- mirtazepine (Remeron®)
Antipsychotics
Antipsychotic medications block the effects of dopamine, a chemical messenger that can increase hallucinations, delusions (false beliefs) and can alter rational thought. Low doses of these medications can help manage aggressive, irrational and compulsive behaviors that may develop with frontotemporal dementia. The potential benefit of antipsychotics must be weighed against potential risks including weight gain, slowing of movement and thinking, accelerating heart disease and, in rare instances, death. Typical antipsychotics are associated with muscle problems and should be avoided, since patients with FTD are likely to show muscle stiffness and trembling.
Examples of atypical antipsychotic medications include:
- olanzepine (Zyprexa®)
- quetiapine (Seroquel® or Ketipinor®)
- risperidone (Risperdal®)
- ziprasidone (Geodon®)
- aripiprazole (Abilify®)
- paliperidone (INVEGA®)
Other classes of drugs that might be useful, but have not been studied in Pick's/FTD are anti-anxiety drugs and anti-seizure medications used as “mood stabilizers.”
- valproic acid and divalproex sodium (Depacon™, Depakene®, Depakote®, Depakote® ER)
- carbamazepine (Tegretol®)
- gabapentin (Neurontin®)
