Prescribing antipsychotics and other psychotropic drugs to people with dementia-related psychosis is challenging. “The research doesn’t give us a clear message,” says David S. Knopman, MD, FAAN, professor of neurology at Mayo Clinic in Rochester, MN. He recommends avoiding the following types of drugs, with a few caveats.

Antidepressants. Drugs to treat depression are good for that purpose but tend to be ineffective in people with dementia-related psychosis, says Dr. Knopman.

Anti-anxiety medications. A benzodiazepine like lorazepam (Ativan) can cause confusion or excessive sedation, says Dr. Knopman. “In situations where you can anticipate extreme agitation—say, if someone doesn’t want to take a shower and routinely gets very upset beforehand—I sometimes suggest having them shower less frequently. When they do shower, try a low-dose benzodiazepine 30 minutes before to make the process go more smoothly,” he says. “Try to avoid daily dosing with benzodiazepines and to use them ahead of agitation and not after it has begun.”

First-generation antipsychotics. This classification includes medications that tend to work by blocking dopamine, including haloperidol (Haldol) and chlorpromazine (Thorazine). “These can cause excessive motor disruption and stiffness,” says Lon S. Schneider, MD, the Della Martin Chair of Psychiatry and Neuroscience at the University of Southern California Keck School of Medicine.