RATIONALE IN ALZHEIMER'S DISEASE: Selective serotonine uptake inhibitors (SSRI) have demonstrated their effectiveness for symptomatic treatment of depression, as well as for behavioral and psychological disorders in dementia patients, particularly in Alzheimer's disease.
Tolerance: SSRI are particularly well tolerated, particularly in comparison with tricyclic antidepressants. Nausea and vomiting may be a problem in old demented patients. Safety studies have shown that tolerance is not modified in patients with Alzheimer's disease. DRUG INTERACTIONS AND PHARMACOKINETICS: Fluoxetine and paroxetine have an inhibiting effect on metabolism of cholinesterase inhibitors which should be avoided. The compounds have a short half-life and non-active metabolites should be preferred. TRAZODONE: Studies conducted in patients with Alzheimer's disease, mixed type dementia, or fronto-temporal dementia have shown the efficacy of trazodone for diverse types of symptoms: sadness, emotional disorders, irritability, fear, psychomotor instability, delirant ideas. Efficacy of SSRI in patients with Lewy body dementia remains to be confirmed.