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)
- White blood cell changes (low counts)
You can learn about other side effects of antipsychotic medications at these links:
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.