Agitation in patients with Alzheimer disease (AD) as well as other dementias causes substantial patient and caregiver distress (believe me; my mother fits this picture well). A recent multicenter North American study with 186 older adults (mean age, 78) with probable Alzheimer disease and clinical agitation was performed using citalopram (titrated to a target dose of 30 mg daily), a common SSRI antidepressant or a placebo.

At 9 weeks, citalopram patients had significantly lower scores on standardized measures of agitation than did controls; caregivers in the citalopram group reported lower stress levels. About 40% of citalopram patients had moderate or better improvement in agitation versus 26%. However, citalopram patients experienced more frequent and more substantial adverse events, including worsening of cognitive function and anorexia, diarrhea, and falls. (1)

So, how do we obtain similar benefits of an SSRI without the obvious side-effects?

Take home:

1. Consider utilizing serotonin stimulating precursors and stimulators with dementia patients such as 5-HTP, SAMe, and St. John’s Wort. (2)
2. Consider reducing brain inflammation with these patients with Turmeric, EGCGs and Omega 3s. We utilize a self-named Brain Anti-inflammatory Mix (BAM) that we’ve formulated containing both known anti-inflammatories as well as healers of the Blood-Brain Barrier. I’ve listed our BAM contents below.
3. Also consider dopamine precursors as these have been a literal ‘miracle drug’ for my mother. Think phenylalanine and tyrosine, NAC, ALA, as well as Mucuna pruriens. (3)

(1) Citalopram Reduces Agitation in Some Patients with Alzheimer Disease Thomas L. Schwenk, MD reviewing Porsteinsson AP et al. JAMA 2014 Feb 19. Small GW. JAMA 2014 Feb 19.
(2) Altern Med Rev. 1998 Aug;3(4):271-80. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Birdsall TC
(3) Acta Paediatr Suppl. 1994 Dec;407:86-8. Dopamine precursors and brain function in phenylalanine hydroxylase deficiency. Lou HC

Here are our BAM contents:
• Ginkgo powder
o exhibit monoamine oxidase inhibition, as well as inhibition of reuptake at the serotonin, dopamine, and norepinephrine transporters, Ginkgo extract has in addition been found to act as a selective 5-HT1A receptor agonist
• Turmeric (Curcumin) powder
o wide range of biological effects including anti-inflammatory, antioxidant, anti-tumor, antibacterial, and antiviral activities
• Boswelia powder
o Natural anti-inflammatory and good for relieving pain
• White Willow Bark powder
o pain-relieving and anti-inflammatory effects
• Ginger Root powder
o According to the American Cancer Society, ginger has been promoted as a cancer treatment “to keep tumors from developing”
o As a natural anti-inflammatory product, it may affect arthritis pain or have blood thinning and cholesterol lowering properties
• Green Tea EGCG powder
o Natural IL-6 reducer, reducers all inflammatory cytokines, too many uses to list
• Nettle Root Extract powder
o contains active compounds that reduce TNF-α and other inflammatory cytokines
• Arnica Extract powder
o Natural anti-inflammatory and good for relieving pain
• Celery seed powder
o Natural anti-inflammatory and good for relieving pain
• Astaxanthin Algae powder
o beneficial in cardiovascular, immune, inflammatory and neurodegenerative diseases. Some research supports the assumption that it may protect body tissues from oxidative and ultraviolet damage through its suppression of NF-κB activation
• Eleutherococcus Senticosus powder (Siberian Ginseng)
o an adaptogen and there is a wide range of health benefits attributed to its use in herbal medicine.
o In Chinese herbology, E. senticosis is used by people with bone marrow suppression caused by chemotherapy or radiation, angina, hypercholesterolemia, and neurasthenia with headache, insomnia, and poor appetite
• Rosemary powder
o medicinally to improve memory, relieve muscle pain and spasm, stimulate hair growth, and support the circulatory and nervous systems
o Long term daily intake of rosemary prevents thrombosis.
o rosemary has been shown to have antioxidant properties. Antioxidants can neutralize harmful particles in the body known as free radicals, which damage cell membranes, tamper with DNA, and even cause cell death
• Schizandra powder
o phytoadaptogen exerts an effect on the central nervous, sympathetic, endocrine, immune, respiratory, cardiovascular, gastrointestinal systems, on the development of experimental atherosclerosis, on blood sugar and acid-base balance, and on uterus myotonic activity
• Bacopa powder
o improve mental functioning, including comprehension, memory and recollection