Depression Symptoms Treatment

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Dosing and Choice of Dosage Form

Table 4 describes dosing schedules for benzodiazepine and antipsychotics used to treat agitation and aggression. Oral administration of any of the medications is preferred when the patient is cooperative, except in cases of acute risk of self-harm or danger to others. The agitated individual should first be given the opportunity to take their medication by mouth. Giving the patient a choice also offers a needed sense of empowerment and may improve future cooperation. However, if the patient is uncooperative, combative, or “cheeks” medication, then IM administration is used. IM dosing gives assurance that the dose was received, eliminating any problems with noncompliance. However, many patients may resist the injection, often aggressively, in cases of involuntarily medicating a patient.

Pharmacokinetically, the fastest onset of effect occurs with the intravenous (IV) route, however in most psychiatric settings, IV access is not available. A patient may need the IM form initially, but should be converted to oral tablets or solution once cooperation is assured.

Patients being treated for acute agitation should be observed every 15 to 30 minutes for the first 2 hours following medication administration to identify adverse effects (orthostasis, dystonia, confusion, lethargy, sedation) and to determine response. If the patient remains agitated, the dose can usually be repeated in the next 1-2 hours with minimal risk. Even if they calm, over the next 24 hours or longer patients should be watched for a return of the agitated behaviors. In most patients, orders for medications to treat agitation and aggression are written as “prn.” If the patient needs repeated doses of the “prn,” it may be best to schedule the medication for the next few days, then switch back to a “prn” status once the behavior is better controlled. (Such orders should state the amount of drug not to be exceeded within 24 hours.)