Depression Symptoms Treatment

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Thioridazine is authorised in the world under the following brand names: Aldazine, Mallorol, Malloryl, Meleril, Mellaril, Mellaril Hydrochloride, Mellaril-S, Mellarit, Mellerets, Mellerette, Melleretten, Melleril, Metlaril, Novoridazine, Orsanil, Ridazin, Ridazine, Sonapax, Sonapax Hydrochloride, Stalleril, Thioridazine Hcl Intensol, Thioridazine, Prolongatum, Tioridazin.

Patients with dementia display a broad range of cognitive impairments and behavioral and psychotic symptoms. Common behavioral symptoms include verbal and physical aggression, hyperactivity, disinhibition, and pacing and wandering; common psychotic symptoms include paranoia, delusions and hallucinations. These behavioral and psychotic symptoms are the leading cause for the use of more restrictive supervised environments, including institutionalization.

Effective pharmacologic and nonpharmacologic treatment of these symptoms is desirable and, in addition, might delay nursing home placement. Pharmacologic and nonpharmacologic interventions are indicated based upon consideration of the safety of both the patient and those around them. Conventional antipsychotic drugs have limited value for psychotic and behavioral symptoms, but recently the results of several large controlled trials of atypical antipsychotic drugs have become available.

Conventional Antipsychotics

The use of conventional antipsychotic drugs in patients with dementia has a long history of concerns regarding limited efficacy as well as adverse effects that often exceed any therapeutic benefits. In the 1980s, these concerns led to the nursing home provisions of the 1987 Omnibus Budget Reconciliation Act (OBRA 1987) mandating reductions of antipsychotic drugs in an effort to limit their use. OBRA 1987 identified specific indications for antipsychotic drugs that included psychotic symptoms and specific aggressive behaviors, and it also identified symptoms of impaired memory, uncooperative attitude, poor self-care and wandering as inappropriate indications for antipsychotic drug therapy. It was recognized that while low doses of conventional antipsychotic drugs (e.g., haloperidol [Haldol] 1 mg/day to 3 mg/day) could be effective for severe aggressive behaviors and psychotic symptoms, higher doses could in fact worsen cognition. Furthermore, extrapyramidal effects could limit improvements in quality of life achieved through improvement in behavioral symptoms.

In 1990, Schneider et al. published a meta-analysis of controlled clinical trials of conventional antipsychotic drugs published from 1954 to 1989. While the authors concluded that these drugs were effective, only 18% of patients received beneficial effects beyond those from placebo. A later meta-analysis evaluated published studies from 1962 to 1995 comparing conventional antipsychotic drugs to placebo in treating behavioral disorders of dementia. Their conclusion was similar in that no significant difference was found in efficacy between individual antipsychotic drugs, with a modest therapeutic benefit of 26% for antipsychotic drugs beyond that from placebo.

Thioridazine (Mellaril) and haloperidol have been the most commonly used drugs in this patient population. Thioridazine poses particular concerns regarding orthostasis, anticholinergic effects and sedation, while haloperidol carries a high risk of movement disorders and the need to use an anticholinergic drug to treat them. Daily doses of haloperidol above 2 mg or of thioridazine above 75 mg tend to be less effective and are associated with greater adverse effects.