Amid the roar over off-label use of antipsychotics in nursing homes, a new study from the Journal of Clinical Psychiatry raises some new questions.
This study looked at the four most commonly-used atypical antipsychotics in 332 people for up to 2 years. They found (1) lack of significant improvement, (2) a high discontinuation rate, and (3) high rates of both serious and minor adverse events for all four drugs.
But here’s the shocker (two, actually):
(1) Rather than just studying people of advanced age, the subjects were aged 41 and up (mean age in the 60s).
(2) This was not simply a study of people living with dementia. It also included people living with schizophrenia, mood disorders, and post-traumatic stress disorders.
The authors concluded that, “Notwithstanding the limitations, the results of our study are sobering.” Unfortunately, they fall into the common trap of saying, in effect, that “there’s no better pill to date, so we’re stuck.” But many of us working with people who live with dementia have found that the idea of a pill is often a flawed approach to the larger problem of eroded well-being.
One could certainly argue that the neurochemistry of schizophrenia (with up-regulated dopamine activity) still demands some pharmacologic approach. And many will follow the standard disclaimer that “this is just one study, and corroborating studies need to be conducted before we can jump to any conclusions.” But we cannot ignore the growing evidence that we need to seriously re-think our current use of antipsychotics, which garnered over $12 billion in US sales in 2011 (29% of which was dispensed by long-term care pharmacies).
We are bucking a rising trend. Antipsychotics have become a mega-industry in search of consumers. Here are two examples of this disturbing trend:
(1) Last fall in Psychiatric News¸ Army officials discussed the growing use of antipsychotics in our military personnel; not just for PTSD, but also for insomnia, as they were felt to be safer than drugs like Ambien, which can occasionally cause sleepwalking.
(2) There is also a growing trend to medicate our schoolchildren, including the use of antipsychotics for such new diagnoses as “oppositional disorder”.
Do we really know the long-term risks of these trends? What are we doing when we create more categories to justify the use of such questionable medications in so many people?
This article should spur more serious debate about the paradigms we follow and the adoption of new approaches that focus on the person. That’s not just a buzzword anymore.