Jacobs Journal of Internal Medicine

The Urgent and Unmet Need for Safe and Effective Treatment of Agitation

Published on: 2018-08-23


Agitation may occur in many settings: upon emergence from anesthesia, in the context of certain mental illnesses, secondary to brain injury or substance abuse, as a side effect of medication, and with certain forms of cognitive impairment. Agitation occurs frequently in patients with dementia, including but not limited to Alzheimer’s disease. This neuropsychiatric symptom is likely related to dysfunctional neurotransmissions, but the exact mechanisms remain unknown. There is no FDA-approved treatment for agitation but several agents are used off-label to help manage agitation, which can be a chronic and troublesome condition in patients with dementia. Antipsychotics, antidepressants, opioid analgesia, cannabinoids, antiepileptic agents, dextromethorphan, scyllo-inositol, brexipiprazole, and prazosin are discussed as possible treatments in the literature. The effectiveness of many pharmacological interventions for agitation can be equivocal and safety issues are of concern. Nonpharmacological interventions, such as music therapy, aromatherapy, and animal-assisted therapy, have reported modest success but may be difficult to implement emergency departments as well as in some institutionalized settings. As the geriatric population in developed nations increases, agitation secondary to various forms of dementia will likely increase as well. Agitation can pose risks to patients and their caregivers and there is an urgent unmet medical need to find safe, effective treatments.