A 67-year-old male with probable AD and a history of depression was evaluated for worsening auditory and visual hallucinations, paranoia, anxiety, anger and frustration. He presented with persistent agitation, anger outbursts and shuffling gait. The patient repeatedly called his son every day. At the time of evaluation, he was taking quetiapine 100 mg, memantine 20 mg and sertraline 100 mg daily; trazodone 50 mg was added for insomnia a few weeks later. Lithium 150 mg was added and titrated up to 600 mg daily in intervals of 150 mg every two weeks. After six weeks on lithium, olanzapine 15 mg daily was added, and quetiapine was stopped. At the final clinic visit he remained on olanzapine 15 mg, sertraline 100 mg, trazodone 50 mg and lithium 600 mg daily. He exhibited marked reduction in symptoms with a decrease in anger outbursts, physical aggression, paranoid delusions and accusations, and improved gait after 12 weeks on lithium and 6 weeks on olanzapine. His serum lithium level was 0.30 mmol/L at 12 weeks and he experienced no adverse events. The patient's agitation was effectively managed during 24 months of follow-up, although he was institutionalized when his disease progressed.