It is very important for patients to not feel too discouraged if the first medications used are less than optimally effective or that there are problematic side effects. A sign of a competent and compassionate psychiatrist is her willingness to be persistent in carrying out systematic medication trials until the best treatment is finally identified. Sometimes side effects can be minimized; however, many people end up having to find ways to tolerate some side effects. Obviously, this is not pleasant, but is ultimately necessary to reduce or eliminate severe mood swings. Unfortunately, a very small number of people are simply unable to tolerate any bipolar medications.
In sedative-hypnotic detoxification, the patient is prescribed an equivalent dosage of phenobarbital ( Table 6 ) . 5 Phenobarbital is preferred because it has a long half-life and thus does not have to be covered for its own subsequent withdrawal state. The duration of the detoxification program is determined by the drug that has been abused. The patient who has abused a short-acting sedative-hypnotic drug such as alprazolam or zolpidem can be detoxified in seven to 10 days, whereas the patient who has abused an intermediate-acting sedative-hypnotic such as diazepam, phenobarbital or glutethimide requires 10 to 14 days of detoxification.
An assessment for an underlying cause of behavior is needed before prescribing antipsychotic medication for symptoms of dementia .  Antipsychotics in old age dementia showed a modest benefit compared to placebo in managing aggression or psychosis, but this is combined with a fairly large increase in serious adverse events. Thus, antipsychotics should not be used routinely to treat dementia with aggression or psychosis, but may be an option in a few cases where there is severe distress or risk of physical harm to others.  Psychosocial interventions may reduce the need for antipsychotics.