In Part 2 of our series on Behavioral and Psychological Symptoms of Dementia (BPSD), Eric Gordon, PA-C, and Dr. Steve Arze dive into one of the toughest clinical challenges in geriatrics and post-acute care: when and how to use medications to treat behavioral symptoms in dementia.

Building on last episode’s discussion of non-pharmacologic strategies, this conversation tackles the realities of prescribing in complex older adults, where polypharmacy, overlapping symptom presentations, and regulatory pressures converge.

• Why medications are not first-line treatment and what must be ruled out before reaching for a prescription.

• How serotonin toxicity is often missed, how it mimics BPSD, and why stacking serotonergic agents can fuel agitation, sleep disruptions, tremors, and worsening confusion.

• Which medication classes have evidence and which don’t, including:

  • SSRIs

  • Trazodone

  • Anticonvulsants (valproate, gabapentin)

  • Benzodiazepines

  • Melatonin

  • Cholinesterase inhibitors

• Why valproic acid and gabapentin are widely used but poorly supported for BPSD.

• Why benzodiazepines should generally be short-term “bridge” therapy, not long-term solutions.

• The surprising truth about ABH gel (spoiler: the massage may work better than the medication).

• Key takeaways from Fast Facts #499 from the Palliative Care Network of Wisconsin.

• How cholinesterase inhibitors may still help with behavior even in advanced dementia—and when to consider a trial.

• The importance of continual reassessment to avoid “set it and forget it” prescribing.

This episode is packed with practical pearls for clinicians practicing in SNFs, ALFs, home-based care, hospice, and geriatrics—helping you identify what truly works, avoid common pitfalls, and manage behaviors safely and effectively.