Some Psychiatric Meds Dangerous for Dementia Patients

By Jane Farrell

Psychiatric drugs prescribed to patients suffering from Alzheimer’s or other kinds of dementia appear to be riskier than previously believed, researchers say.

The finding, published in JAMA Psychiatry, is adds to the growing body of troubling evidence that has been found in researching the use of antipsychotic drugs as a treatment for dementia-related hallucinations, delusions, agitation and aggression.

For their study, researchers from the University of Michigan Medical School and VA Center for Clinical Management Research analyzed findings from nearly 91,000 American veterans over the age of 65 with dementia.

They compared data from patients who were given psychiatric medication with those who weren’t.

According to a news release from the University of Michigan Health System, patients taking antipsychotics had “outsize risks of death.” With patients who took the newer, more commonly used antipsychotics, the risk climbed along with the dose.

The researchers looked at other psychiatric medicines as well. They found that the risk of death with the mood stabilizer valproic acid was similar to the antipsychotics. Antidepressants had less risk compared with antipsychotics and valproic acid, the investigators found. But it was still higher than that of those not taking any psychiatric medications to treat behavior issues in dementia.

The U.S. Food and Drug Administration (FDA)  has warned that the use of antipsychotic drugs in people with dementia is linked to increased risk of cardiovascular events and even death.

“The harms associated with using these drugs in dementia patients are clear, yet clinicians continue to use them,” said lead author and U-M/VA psychiatrist Donovan Maust, M.D., M.S. “That’s likely because the symptoms are so distressing. These results should raise the threshold for prescribing further.”

University of Michigan researchers have previously suggested a management regimen called DICE (Describe; Investigate; Create; Evaluate) that would be less focused on medication.

However, the approach takes more time than writing a prescription..

“Non-pharmacologic approaches will only succeed if we as a society agree to pay front-line providers for the time needed to ‘do the right thing’,” said study co-author Helen Kales, M.D.