Are antipsychotic drugs more dangerous to dementia patients than we think?

http://www.eurekalert.org/pub_releases/2015-03/uomh-aad031615.php

Public Release: 18-Mar-2015
University of Michigan Health System

Drugs aimed at quelling the behavior problems of dementia patients may also hasten their deaths more than previously realized, a new study finds.

The research adds more troubling evidence to the case against antipsychotic drugs as a treatment for the delusions, hallucinations, agitation and aggression that many people with Alzheimer's disease and other dementias experience.

In the new issue of the journal JAMA Psychiatry, researchers report findings from nearly 91,000 American veterans over the age of 65 with dementia.

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Those taking drugs called antipsychotics had outsize risks of death. Among those taking the newer, more commonly used antipsychotics, the risk climbed along with the dose.

The study also examined other psychiatric medications. The risk of death seen with the mood stabilizer valproic acid was similar to the antipsychotics. Antidepressants had less risk compared with antipsychotics and valproic acid, but it was still higher than that of those not taking any psychiatric medications to treat behavior issues in dementia.

Antipsychotic drugs have significant risk of side effects, and the U.S. Food and Drug Administration warns that their use in people with dementia is associated with increased risk for cardiovascular adverse events and the risk of death.

"The harms associated with using these drugs in dementia patients are clear, yet clinicians continue to use them," says lead author and U-M/VA psychiatrist Donovan Maust, M.D., M.S. "That's likely because the symptoms are so distressing. These results should raise the threshold for prescribing further."

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The "DICE" approach to assess and manage behavioral symptoms in dementia that has been put forth by Kales and colleagues could help.

This approach emphasizes putting non-pharmacological strategies first. But the approach takes more time than writing a prescription, and its use will depend on the support of policy-makers and alignment of reimbursement strategies.

"In other words, non-pharmacologic approaches will only succeed if we as a society agree to pay front-line providers for the time needed to 'do the right thing'," says Kales.

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