Antipsychotics Even Riskier For The Elderly Than Previously Thought

Rob Wipond
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Antipsychotic medications that are commonly being used to help control behaviors in elderly people with dementia seem to be causing premature deaths at higher rates than previously thought, according to a study in JAMA Psychiatry.

The University of Michigan-led team examined records for nearly 91,000 elderly veterans with dementia between 1998 and 2009, who had been treated with either of several psychiatric drugs or had received no psychiatric drugs at all. They then calculated the “number needed to harm” (NNH), or the number of people who had to be taking a particular class of psychotropics in order for one of them to die within six months.

“The results, published this week in JAMA Psychiatry, showed that mortality risks statistically increased in patients taking antipsychotics to reduce symptoms of dementia, compared with individuals not being treated,” reported Psychiatric News. “Haloperidol was observed to be the riskiest — with one death per every 26 individuals taking the drug. Risperidone had a NNH of 27, followed by less risky olanzapine and quetiapine with NNHs of, respectively, 40 and 50. The researchers also observed the mortality risk for older adults with dementia who took antidepressants. The mortality risks were lower — with one person dying for every 166 individuals taking the medication.”

The researchers concluded in their abstract, “The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose.”

“We hope this creates a dialogue about the advantages and disadvantages of antipsychotic and other psychotropic use as first-line treatment strategies for behavioral symptoms,” one of the researchers told Psychiatric News.

“These risks are two to four times higher than previously cited in the medical literature,” reported MinnPost. “Another troubling finding was that people prescribed haloperidol — the riskiest of the drugs — were more likely to be unmarried, African-American or living in facilities with fewer beds for patients.”

Maust DT, Kim H, Seyfried LS, et al. Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm. JAMA Psychiatry. Published online March 18, 2015. doi:10.1001/jamapsychiatry.2014.3018. (Abstract)

Are antipsychotic drugs more dangerous to dementia patients than we think? (University of Michigan Health System press release on ScienceDaily, March 18, 2015)

Antipsychotic drugs are riskier for older dementia patients than previously thought, study finds (MinnPost, March 19, 2015)

Mortality Risk High for Dementia Patients Taking Antipsychotics, Study Finds (Psychiatric News Alert, March 20, 2015)

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6 COMMENTS

  1. “Another troubling finding was that people prescribed haloperidol — the riskiest of the drugs — were more likely to be unmarried, African-American or living in facilities with fewer beds for patients.”

    Isnt’ that code for racism, homophobia and treating the poor like scum?

    • The only time I was ever put on Haloperidol was when I was medically unnecessarily force hospitalized by V R Kuchipudi and Humaira Saiyed at the ELCA Advocate Good Samaritan hospital in Downers Grove, IL. On the first day alone, this 142 lb pacifist was put on 15mg Haloperidol (5mg is recommended highest dose), plus 6mg benztropine (2mg is recommended highest dose), 9mg lorazepam (4mg is recommended highest dose), 30mg Geodon, 325mg Tylenol, 30mg Mi-Acid II, 30mg Milk of Magnesia, and 30mL didronel – at least that what it looked like from reading the medical records.

      During the next 10 days I was put on similar quantities of drugs, but different, willy nilly drug cocktails also including up to 1500mg Depakote ER (60 mg is recommended highest dose), 600mg Seroquel, Darvocet A500 (withdrawn from the US market in 2010), and Midrin. I think the FBI should arrest Saiyed for medically unnecessarily “snowing” patients, not just Kuchipudi.

      But the ELCA Advocate Good Samaritan hospital lawyer claims this type of “snowing” is “appropriate medical care.” I don’t recommend that hospital.

  2. The UN stated “forced psychiatric treatment is torture.” Why are doctors torturing the elderly and children in this country with these psychiatric treatments? And the antipsychotics / neuroleptics are known to cause the schizophrenia symptoms:

    “Agents with anticholinergic properties (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; disopyramide) may have additive effects when used in combination. Excessive parasympatholytic effects may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    Why would anyone with a brain in their head think it appropriate to put someone with dementia on a drug class known to cause memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, and hyperactivity? Strikes me as completely illogical.

  3. I just learned about the NNH (number needed to harm), and think it’s a great companion to the NNT (number needed to treat). It’s the best illustration I’ve seen of the numbers to help people weigh risks and benefits. Of course, population statistics rarely translate for the individual. You either suffer a harm or don’t; but populations like the elderly have always been particularly at risk. There’s a reason why geriatric medicine exists.

    We need to start spending money on adequate resources and training in care homes, instead of using drugs as social control.

  4. Neuroleptics can cause a person to lose their will to live and the corresponding loss of hope that is the result of neuroleptic use probably plays a role in some of these early deaths. The use of these chemicals on people against their will is evil.