Paroxetine for verbal agitation

Objective: To examine by direct observation the effect of a selective serotonin reuptake inhibitor (SSRI), paroxetine, on verbal agitation in nursing home residents diagnosed with dementia. Design: A before-and-after trial consisting of case series of 15 patients each followed for a period of four months. Setting: Two long-term care skilled nursing facilities. Participants: Fifteen consecutive nursing home residents diagnosed with dementia and exhibiting verbal agitation in the form of screaming, repetitious questions or phrases, and constant request for attention. Intervention: Subjects received 10 mg to 20 mg of paroxetine orally once daily. Measurements: The Cohen-Mansfield Agitation Inventory (CMAI) was used to rate the agitated behavior. A baseline score was obtained before starting paroxetine. Two scores were then obtained over two-week periods, one month and three months after starting paroxetine. The authors also used another behavior scale that rated the presence or absence of verbalizations over each of the three nursing shifts. Daily verbalization scores (VS) ranged from 0 (no verbalizations) to 3 (verbalizations occurred on each of the three nursing shifts). Monthly scores (range, 0 to 90) were obtained by adding the daily scores (range, 0 to 3). Results: All subjects had a reduction (range, 29% to 86%; average, 62%) in their CMAI agitation scores at the end of the first month of treatment with paroxetine. Scores were further reduced (range, 50% to 86% from baseline; average, 70%) at the end of the third month of treatment. Similar degrees of reduction were measured using the monthly VS (67% at one month and 94% at three months). Conclusion: Previous studies have associated verbally and physically agitated behaviors with decreased serotonin levels in the brain. Serotoninergic treatment of screaming with trazodone and L-tryptophan has been reported. However, since the advent of the newer class of SSRIs, there have been no reports on their use for verbally agitated behaviors. This study demonstrates clinically measurable reduction in verbal agitation with the use of a potent SSRI, paroxetine.