APA Recommends Reducing Antipsychotics for Children and Elderly Without Psychosis


The American Psychiatric Association, as part of the American Board of Internal Medicine’s “Choosing Wisely” initiative, released new practice guidelines yesterday that advise against prescribing two or more antipsychotics concurrently, using antipsychotics as a “first choice” for treating behavioral symptoms of dementia, as a “first-line intervention for insomnia”, or as a “first line intervention for children and adolescents for any diagnosis other than psychotic disorders.”

APA Press Release →

Of further interest:
Choosing Wisely (APA Website)
Doctors: Anti-psychotic meds overused for dementia, kids (USA Today)
APA releases guidelines on cutting antipsychotic overuse (Cleveland.com)

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Another misleading MIA summary. The guide never advises not to use neuroleptics as a first-line treatment for children without psychotic disorders. It advises them not to use them as first-line treatments ROUTINELY.

    I’m quite sure that most psychiatrists read that advice as saying that they should just be a bit more careful in determining WHICH children “need” the drugs as first-line interventions, as opposed to just prescribing them to every child that is brought to their office, which of course is the routine.

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  2. Nonetheless, I am going to find this very helpful in advocating for foster kids, who seem to get antipsychotics for any kind of distress they experience. I always get the “you’re not a doctor” routine, even though I know more about the effects and outcome literature of psych drugs than a lot of the docs. But this will be hard to refute.

    —- Steve

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  3. And where are all these psychiatrists who are willing to talk with their patients about medications? Out of the four that I’ve personally dealt with, one and one only was willing to actually talk about the drugs and how they would affect me.

    I agree that it does give us some ammunition to use in our pushback against the system and the rampant drugging of children.

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