This week, Mad in America examines four new studies around harms linked to psychiatric drug use. The first finds that psychiatric drug use is linked to increased risk of death, falls, and cognitive decline in people diagnosed with dementia. The second reports that antipsychotics are associated with increased risk of death in dementia patients. The third finds that psychiatric drugs are linked to increased risk of acute kidney injury, kidney disease, falls, and fall related injuries, The fourth finds that benzodiazepine use as prescribed is linked to increased risk of suicide.
Psychiatric Drugs Linked to Increased Risk of Death, Falls, and Cognitive Decline in People With Dementia
A new article published in Research in Social and Administrative Pharmacy finds that psychiatric drugs are linked to several adverse outcomes in people diagnosed with dementia, including increased risk of death. This research, led by Fiona Carabine from Queen’s University Belfast in the UK, recommends regular medication reviews and deprescribing approaches to avoid and reduce harm in people living with dementia.
The goal of this study was to examine adverse outcomes and the prevalence of drug-related harm in dementia patients. The authors preformed a systematic review and meta-analysis of previous research around this topic. Included studies had to be peer-reviewed, published in English, and have the full-text available. In total, the authors used data from 115 studies. The majority came from Europe (71), followed by North America (23), Asia (12), Australia (7), and South America (2).
Fifty-nine included studies examined psychiatric drugs, with 43 linking these drugs to adverse outcomes in people with dementia. A meta-analysis of 6 studies, including 25,715 participants, found that antipsychotics were linked to a 42% increased risk of death. Anxiolytics, antipsychotics, and antidepressants were all associated with increased risk of falls and fractures. Sedatives, antidepressants, and drug combinations with a high anticholinergic burden, including tricyclic antidepressants and typical antipsychotics, were linked to increased risk of cognitive decline. Psychiatric drugs were also linked to increased rates of hospitalization, emergency room visits, and longer inpatient stays.
This research had three main limitations. Included studies used different outcome measures, terminology, and designs. The majority of included studies were observational. This means the findings cannot definitively say that psychiatric drugs are causing the adverse outcomes. Only studies published in English were included, limiting generalizability.
Antipsychotics Linked to Increased Risk of Death in Dementia Patients
A new study published in Frontiers in Psychiatry finds that antipsychotics are linked to increased risk of death in people diagnosed with dementia. This research, led by Poe Eindra Thant from Lund University in Sweden, also reports that these drugs were linked to stroke, but that finding did not reach statistical significance in their meta-analysis.
The goal of this study was to investigate adverse outcomes related to antipsychotic use in people diagnosed with dementia. The authors performed a systematic review and meta-analysis of studies around adverse outcomes and antipsychotic use in dementia patients. Included studies were published between January 1, 2010 and August 14, 2024. Studies involving Parkinson’s disease dementia were excluded. In total, the authors used data from 45 studies including nearly 2 million participants.
The clearest finding in the current meta-analysis was the link between antipsychotics and increased risk of death. Overall, antipsychotics were linked to a 32% increased risk of death. This was true for both typical (25% increased risk) and atypical (23%) antipsychotics. The meta-analysis also reported a 77% increased risk of stroke, but that finding did not reach statistical significance. The authors note that due to included studies using varying methods, effect measures, and follow-up periods, other adverse outcome risks could not be meaningfully pooled in their analysis. However, individual studies did report increased risk of numerous adverse effects related to antipsychotic use in people with dementia, including:
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Pneumonia
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Fractures
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Falls
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Orthostatic hypotension
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Head injury
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Traumatic brain injury
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Myocardial infarction (heart attack)
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Heart failure
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Venous thromboembolism
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Acute kidney injury
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Hospitalization
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Long-term care/nursing-home admission
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Acute cardiac events
The risk of adverse outcomes was especially elevated in the first week following the start of antipsychotic use.
This study had three main limitations. Most of the included studies were observational, meaning the results cannot say for sure that antipsychotics are causing these adverse outcomes, only that they are linked. Included studies used varying designs, settings, measures, populations, and follow-up periods. Most included studies came from high-income countries and involved elderly patients. This limits generalizability to low- and middle-income countries and populations of younger people diagnosed with dementia.
Psychiatric Drugs Linked to Increased Risk of Acute Kidney Injury, Kidney Disease, Falls, and Fall Related Injuries
A new study published in Frontiers in Pharmacology finds that psychiatric drugs are linked to significantly increased risk of acute kidney injury. This study, led by Yu-Hsien Wu from the Taichung Veterans General Hospital in Taiwan, also reports that these drugs are associated with increased risk of falls, fractures, head injury, vertigo, and rhabdomyolysis.
The goal of this research was to examine links between psychiatric drug use and acute kidney injury, kidney disease, falls and related injuries, vertigo, and rhabdomyolysis. The authors used data from TriNetX, a global health research database. Adult psychiatric drug users were matched with non-users based on demographic information including medical ailments, psychiatric diagnosis, and neurological conditions. In total, the authors analyzed data from 169,309 matched pairs. Each pair was followed for five years.
Psychiatric drug users had significantly increased risk of acute kidney injury (83%). Psychiatric drugs were also associated with new onset stage 3 chronic kidney disease (21% increased risk) and advanced chronic kidney disease (28%). In addition to kidney disease, psychiatric drugs were linked to increased risk of falls (2.32 times more likely) and fall related injuries including fractures (85% increased risk), head injury (88%), vertigo (81%), and a more than tripled risk of rhabdomyolysis (3.71 times more likely). The authors note that these “associations were generally consistent across medication classes, age groups, and sex.”
This study had several limitations. It is possible that unmeasured factors may have differed between participants. Underlying psychiatric and neurological conditions may have contributed to fall risk or kidney disease. The available data indicated that patients were prescribed psychiatric drugs, but cannot establish that they actually took the drugs. This data also did not capture some variables that could have affected the results such as dose, adherence, treatment changes, and duration of drug exposure.
Benzodiazepines Use as Prescribed Linked to Increased Risk of Suicide
A new study published in BMC Psychiatry finds that benzodiazepine use is linked to significantly increased risk of suicide and suicide attempts. This research, led by Zelfa Hamadieh from the City University of New York, concludes that prescribing guidelines around benzodiazapines should be refined and users should be regularly assessed for suicide risk.
The authors conducted a systematic review and meta-analysis of research around prescribed benzodiazepine use and suicide. Included studies were published in English between October 2016 and January 2025. Studies that looked at illicit benzodiazepine use, misuse, polysubstance use, and suicidal thoughts or self-harm without suicidal behavior were excluded. In total, the authors used data from 21 studies.
Overall, benzodiazepine use was linked to a more than doubled (2.74 times more likely) risk of suicide or suicide attempt. This association persisted in sensitivity analysis for studies that reported odds ratios (2.79 times increased risk) and hazard ratios (doubled risk). When including only higher-quality studies, benzodiazepine use as prescribed was still linked to a more than doubled risk of suicide or suicide attempt (2.45 times increased risk).
This research had four main limitations. The included studies used varying methods and reporting measures. The authors excluded studies related to illicit benzodiazepine use, misuse, and polysubstance use, limiting generalizability to populations not using these drugs as prescribed. Included studies were published in English, limiting generalizability to non-English speaking populations. The authors did not analyze factors such as dose, duration of exposure, patterns of use, or type of benzodiazepine (short- versus long-acting).
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Carabine, F., Hughes, C. M., & Barry, H. E. (2026). The prevalence and impact of medication-related harm in people living with dementia − a systematic review and meta-analysis. Research in Social and Administrative Pharmacy, 22(12), 1061–1074. (Link)
Hamadieh, Z., Goldfarb, D. G., & Ellendon, N. (2026). Prescribed benzodiazepines and suicidal behaviors: A systematic review, meta-analysis, and clinical implications. BMC Psychiatry, 26(1). (Link)
Thant, P. E., Zenker, A., Jarl, J., Gerdtham, U.-G., Lenander, C., Persson, S., & Saha, S. (2026). The consequences of antipsychotic medication use for people living with dementia: A systematic review and meta-analysis. Frontiers in Psychiatry, 17. (Link)
Wu, Y.-H., Tsai, S.-F., Huang, S.-S., & Hou, P.-H. (2026). Psychotropic medication use and risks of kidney injury and fall-related events: A propensity score–matched cohort study. Frontiers in Pharmacology, 16. (Link)
