Psychiatry, It's A Killing.: Antipsychotics Even Riskier For The Elderly Than Previously Thought

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Antipsychotic medications that are commonly being used to help control behaviors in elderly people with dementia seem to be causing premature deaths at higher rates than previously thought, according to a study in JAMA Psychiatry.

The University of Michigan-led team examined records for nearly 91,000 elderly veterans with dementia between 1998 and 2009, who had been treated with either of several psychiatric drugs or had received no psychiatric drugs at all. They then calculated the "number needed to harm" (NNH), or the number of people who had to be taking a particular class of psychotropics in order for one of them to die within six months.

"The results, published this week in JAMA Psychiatry, showed that mortality risks statistically increased in patients taking antipsychotics to reduce symptoms of dementia, compared with individuals not being treated," reported Psychiatric News. "Haloperidol was observed to be the riskiest -- with one death per every 26 individuals taking the drug. Risperidone had a NNH of 27, followed by less risky olanzapine and quetiapine with NNHs of, respectively, 40 and 50. The researchers also observed the mortality risk for older adults with dementia who took antidepressants. The mortality risks were lower -- with one person dying for every 166 individuals taking the medication."

The researchers concluded in their abstract, "The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose."

"We hope this creates a dialogue about the advantages and disadvantages of antipsychotic and other psychotropic use as first-line treatment strategies for behavioral symptoms," one of the researchers told Psychiatric News.

"These risks are two to four times higher than previously cited in the medical literature," reported MinnPost. "Another troubling finding was that people prescribed haloperidol — the riskiest of the drugs — were more likely to be unmarried, African-American or living in facilities with fewer beds for patients."

Maust DT, Kim H, Seyfried LS, et al. Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm. JAMA Psychiatry. Published online March 18, 2015. doi:10.1001/jamapsychiatry.2014.3018. (Abstract)

Are antipsychotic drugs more dangerous to dementia patients than we think? (University of Michigan Health System press release on ScienceDaily, March 18, 2015)

Antipsychotic drugs are riskier for older dementia patients than previously thought, study finds (MinnPost, March 19, 2015)

Mortality Risk High for Dementia Patients Taking Antipsychotics, Study Finds (Psychiatric News Alert, March 20, 2015)

--Rob Wipond, News Editor