Antipsychotics Increase Death Risk in Alzheimer's Patients

By Dr. Randi Fredricks, Ph.D.

Alzheimer's patients who are prescribed antipsychotic drugs face a higher risk of death than similar patients not given these medications do, British researchers report.

While the short-term use of antipsychotics has been found to benefit Alzheimer's patients, studies have found that prolonged use can have serious side effects, including Parkinson-like symptoms, sedation, chest infections, decline in brain function, stroke and death.

It's an eye-opening study since it was one of the few non-company sponsored studies to look at long-term risks. Antipsychotics are not and never were indicated for use in people with dementia, but millions of elderly people have been put on antipsychotics in nursing homes, often with little or no evidence to support such use.

For the study, the researchers randomly assigned 128 Alzheimer's patients to one of several antipsychotics or a placebo. The antipsychotic drugs included thioridazine, chlorpromazine, haloperidol, trifluorperazine or risperidone.

The researchers found that, for the whole study period, the risk of death was 42 percent lower among people taking a placebo compared with those taking antipsychotics. After one year of follow-up, 70 percent of the patients taking antipsychotics were still living, compared with 77 percent of those on placebo. But after two years, 46 percent of those taking antipsychotics were alive, compared with 71 percent of those taking placebo. After three years, only 30 percent of those on antipsychotics were alive, compared with 59 percent of those taking a placebo, the researchers found.

Despite the findings, there may still a place for antipsychotics in some people with dementia. If there is no other way to stop an Alzheimer's patient from acting dangerously and all other measures have failed, then antipsychotics can be used as a measure of last resort, but only for the shortest possible time at the lowest possible dose.

The study authors found that there is still an important but limited place for atypical antipsychotics in the treatment of severe neuropsychiatric manifestations of Alzheimer's disease, particularly aggression. However, the accumulating safety concerns, including the substantial increase in long-term mortality, emphasize the urgent need to put an end to unnecessary and prolonged prescribing.

Some experts believe that non-pharmacological treatments may be as effective as the antipsychotic drugs and should be considered first. Non-pharmacological treatments are things like changing the environment of the patient, changing the way the patient is addressed, and eliminating certain triggering events that may cause deteriorations in patient behavior.

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About the Author

Dr. Randi Fredricks, Ph.D. is a psychotherapist and author specializing in the treatment of mental health using integrative medicine and natural therapies. She works with individuals, couples, and families at her office in San Jose, California. Dr. Fredricks' publications include the landmark book Healing & Wholeness: Complementary and Alternative Therapies for Mental Health. No part of this article may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems. Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of Dr. Randi Fredricks as articles often present the published results of the research of other professionals. Copyright © 2012.


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