A new study published in The BMJ (British Medical Journal) has uncovered more health risks associated with giving antipsychotic medications to people with dementia than previously believed. The researchers found that antipsychotic drug use was linked to elevated risks of heart attack, stroke, heart failure, blood clots, irregular heart rhythm, pneumonia, fracture, and acute kidney injury when compared to people with dementia who did not take antipsychotics. The study also highlighted that the highest risk of side effects occurs soon after people start taking these medications, emphasizing the need for caution during the early stages of treatment.
The researchers conducted their study by analyzing primary care, hospital, and mortality data in England. They identified 173,910 individuals diagnosed with dementia between January 1998 and May 2018, with 63% of them being women and an average age of 82. Of these individuals, 35,339 were prescribed antipsychotic drugs after their dementia diagnosis, while 15 randomly selected individuals with dementia did not take antipsychotics. The study found that antipsychotic drug use was associated with increased risks for various health outcomes, with risks being highest during the first week of treatment, particularly for pneumonia.
Dr. J. Wes Ulm, a bioinformatic scientific resource analyst not involved in the study, emphasized that antipsychotic drugs can have effects on multiple organ systems and may pose risks, especially for individuals with certain underlying conditions. He suggested individualizing treatment based on the specific risks and benefits for each person and selecting antipsychotics with lower risk profiles when necessary. However, Dr. David Merrill, a geriatric psychiatrist, explained that antipsychotics are prescribed in dementia cases to reduce severe stress and suffering, with a preference for non-pharmacological behavioral treatments as the first line of intervention. Medications should be reserved for recurrent severe behaviors that pose harm to the patient or others, such as hostile aggression.
Dr. Jason Krellman, a neuropsychologist, highlighted the importance of balancing the potential side effects of antipsychotic drugs with the severe behavioral and psychological symptoms that can occur in later stages of dementia. While the study found a wider range of health risks associated with these medications, some patients may benefit from their use to manage severe symptoms. However, caregivers must consider their ability to cope with and manage the challenging behaviors that may arise, as well as the patient’s age, symptom severity, and safety risks when making treatment decisions. Ultimately, the balance between risks and benefits of antipsychotic use in dementia should be carefully evaluated on an individual basis to ensure the well-being of the patient.
