senior woman with her adult daughter

Alzheimer’s disease and other dementias are among the cruelest afflictions known to man. These conditions rob people of their memories, their personalities and their independence. Friends and families bear the brunt of the care taking, until things get so challenging that the patient is placed in a long-term care facility. Not infrequently, people with dementia are given antipsychotic medications to control their anxiety, aggression, delusions or other psychological symptoms. What are the risks of such medications?

The Pros and Cons of Antipsychotic Medications:

Weighing the benefits against the risks of psychiatric drugs is a delicate balancing act. Nowhere is this more apparent than the prescribing of antipsychotic drugs in nursing homes.

Human Rights Watch recently reported that antipsychotic drugs are administered to more than 179,000 people in nursing facilities every week. These patients have not been diagnosed with schizophrenia or other mental illnesses for which the drugs are approved. Instead, many are suffering from dementia.

The FDA Warning:

The Food and Drug Administration is not renowned for nuance. When it comes to antipsychotic medications, the agency has a prominent black box warning on the prescribing information for most such drugs. In upper case and large-sized bold black letters prescribers are told:

“WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS”

“Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.”

The agency notes that antipsychotic medications are
:

“not approved for the treatment of patients with dementia-related psychosis.”

In reviewing data from placebo-controlled trials the FDA reports that:

“Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature.”

Black, White or Shades of Gray?

The FDA’s warnings seem black and white. Unfortunately, many people with dementia live in a confusing world with shades of gray when it comes to treatments. We have heard from many readers concerned about the new expose from Human Rights Watch.

One person wrote to support careful use of antipsychotic medications:

“Anti-psychotics, if chosen and administered carefully, and if the patient is monitored, can be a real life-saver. My father had multiple strokes that disabled him and also had dementia and some depression. The medical team at his nursing home collaborated with family to find the right medications to improve his quality of life by easing his extreme agitation.

“Seroquel, at the lowest possible dose, gave him a semblance of normalcy and got him through early evening, which was typically the worst time for him. It’s important to find the right medication and to read the literature for side effects. Certain drugs increase the risk of 1) falls, and 2) death. Haldol, for instance, is at the top of the list for these risks when used with elderly patients.”

Another person had quite a different experience with antipsychotic medications:

“My very competent independent elderly mother had an acute episode of confusion a few years ago. Instead of getting a thorough workup, she got a (ludicrous) diagnosis of Alzheimer’s (which they told me must have been in hiding until the previous day).

“When her undiagnosed actual condition continued to get worse, her confusion turned into agitation, so they gave her benzos and ultimately added antipsychotics.

“Two months later, she was a vacant, enfeebled shell of herself and had to be moved to assisted living. I spent two years finding better doctors and working with them to eliminate inappropriate meds, including antipsychotics. Today, she is her old competent, well-balanced, intelligent self – but the inappropriate meds took away her independence and two years of her life.”

A health professional’s take on antipsychotic medications:

“I have been on both sides of the issue as well. As a nurse, I see benefits as well as problems with these meds. I am thinking some antianxiety medication is needed at times. It is not a benefit to anyone, including the patients, to have them wandering, crying and agitated all the time. They may attempt to strike the staff.

“I have also seen drooling and patients gorked from too much medication. What quality of life is it to be too agitated and upset? We had to monitor all patients on these meds very closely and I would rather see them used than having none at all. It is a very tough call.”

The People’s Pharmacy Perspective on Antipsychotic Medications:

Drug like aripiprazole (Abilify), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon) are powerful compounds. They can all produce serious adverse reactions. According to the National Institute of Mental Health, here are some potential complications of such drugs.

Side Effects of Antipsychotic Medications:

  • Drowsiness and dizziness
  • Restlessness and uncontrollable movements
  • Muscle spasms, tremors
  • Weight gain
  • Dry mouth
  • Digestive distress (nausea, vomiting, constipation)
  • Blurred vision
  • Hypotension (low blood pressure)
  • Seizures
  • White blood cell changes (low counts)

You can learn about other side effects of antipsychotic medications at these links:

Abilify Side Effects: How Dangerous Are Antipsychotic Drugs?

Quetiapine (Seroquel) Side Effects Are Disastrous

Olanzapine (Zyprexa) Side Effect Ruins Self Image

People’s Pharmacy Perspective:

Antipsychotic medications do not cure mental illness. They are not an antidote to dementia. And they do carry serious risks. But older people suffering from dementia can become agitated and aggressive. They can assault family members and care takers.

There are no easy answers nor magic pills. Clearly, we need far better treatments for both mental illness and brain-robbing conditions such as Alzheimer’s disease.

Until that day arrives, however, use of antipsychotic medications requires very careful medical oversight. Families need to be involved in decisions regarding antipsychotic medications and patients must be monitored for side effects.

Share your own thoughts and experiences on this topic below in the comment section.

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  1. T
    Portland, OR
    Reply

    I recently attended a workshop with presentations by people using Montessori principles for elderly patients. Meds were greatly reduced, depression lifted and the patients feel useful and happy with the changes. Some of the principles embraced (and, yes, this is from Montessori education), were independence, skill building, changing the environment so the residents could be more independent, and, very important, learning about the person in order to understand behavior. Amazing!

  2. Debra
    Seattle
    Reply

    I am a mental health professional and, in general, it’s important to understand the individual way people react to medications. This is a frustrating reality at this time. In fact, studies of medication use in themselves are limited in their scope. I wanted to report that when my own mother, with dementia, became increasingly paranoid and confused, anti-psychotics were a life saver. Here’s the kicker. Her memory improved!! Significantly! I wonder how many psychiatrists have experience with this.

  3. Jim
    Richmond, TX
    Reply

    I am very happy to add my comments. My wife has Alzheimer’s and was diagnosed in 2010. She is at home with constant loving care by me and her full time caretaker but her level of agitation grew enough to keep her from sleeping and having any type of enjoyment, day or night. After much personal research and a very hands-on personal physician we settled on Seroquel (generic is quetiapine). We started at 25 mg twice per day all the way to 150mg. We found her perfect level to be 100mg twice per day. For her, that dosage DOES NOT keep her zoned out. She is very alert but mostly very calm. An interesting observation was that when I tried the Extended Release version of Seroquel, she became just as agitated as if with none. Strange but true in her case. She reverted to her normal self when we went back to the twice/day regular release. All other physical metrics from her routine exams have remained very good with no apparent side effects.

  4. Allan
    College Station, TX
    Reply

    There may be reasonable uses for antipsychotic meds in the elderly, but I have seen mostly the unreasonable uses.
    During my counseling practice I spent many wonderful hours with mentally intact folks who had had to move into assisted living situations purely because of physical limitations in their selfcare. No danger of antipsychotic meds with these folks who were willing and able to do more than staff members thought. However, there were those who were beginning to exhibit dementia symptoms including a fragmentation of their personalities and, in some cases, frank paranoid ideations. If they became resistant to instructions and directions from staff members antipsychotic meds were often introduced. To the eye of this outsider the single reason was to sedate people into an attitude of compliance with the needs of the staff.

  5. Joan D.
    Illinois
    Reply

    My father became super-agressive with caregivers at their senior apartment. His stroke-induced dementia meant that he could not remember how to open the refigerator. ZYPREXA was a lifesaver; He became non-agressive, remembered all of us, had time for caregivers, had memories, could answer correctly any questions. Caregivers told us how nice he was. Dad died at age 95.5.

  6. Nora
    FL
    Reply

    My husband was diagnosed with Temporal-Frontal Lobe dementia which is like Alzheimer’s on steroids. He went into violent rages to the point that our bank, insurance company, and several stores asked him to leave. He once went missing for over 24 hours when he found a hidden car key and drove off. He was intelligent and physically in good shape. I strongly suggested to his neurologist that he be put on Seroquel. We discussed the pros and cons (I am an RN), and he was put on the med. This permitted me to keep him at home for two years before placing him.

  7. N
    New York State
    Reply

    I am just learning about FTD, Fronto-Temporo Degeneration, and how many who have this form of dementia or brain degeneration are actually mis-diagnosed bipolar earlier in life. I think the idea that these medications could actually be the wrong medicines could make medical professionals pause and ask if there are better ways of diagnosing some of these brain conditions. Perhaps actual brain scans or protein tests to diagnose bipolar or dementia could give quantitative data vs the very qualitative data of using symptomatic signs, which often include the family’s or caretaker’s versions of events, which often encourage the prescribing doctor to “overmedicate.” I believe we will need more care-taking facilities in the future for the Baby Boomers who will be afflicted, and we will need more compassionate centers and care providers, hopefully to innovate a kinder way to deal with our aging seniors.

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