Antipsychotics Should be a Last Resort in Dementia Care

We often put our trust in medical professionals to examine us and send us on our way with a prescription that fixes everything.

But for Alzheimer’s and related dementias, there are no miracle prescriptions.

Medications that cure or alter the course of Alzheimer’s disease don’t exist.

There are a handful of drugs approved by the United States Food and Drug Administration (FDA) to delay the symptoms of Alzheimer’s.

But there are no drugs approved by the FDA to treat dementia related behavioral symptoms.

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Introduction to Alzheimer’s Medications and Off Label Prescriptions

However, doctors and other medical professionals are allowed to issue prescriptions for off-label use. Unfortunately, this is often done as a first resort instead of observing and understanding the cause of the behavior.

In my article, The Overuse of Antipsychotics in Dementia Care, which was originally published on Next Avenue, I discuss how while there are limited instances when the use is appropriate, the overuse makes it seem appropriate to the untrained family caregiver.

The article is republished here for your convenience:

The Overuse of Antipsychotics in Dementia Care

When you’re new to a complex disease such as Alzheimer’s or another type of dementia, it’s nearly impossible to know what’s right and what’s wrong. All of our lives we have put our trust in the medical professionals who examine us and send us on our way with a prescription that fixes everything.

But nothing is simple in dementia care where a person’s behaviors might change on a dime and their ability to clearly communicate is impacted by the disease.

In our ignorance to believe there’s a miracle medication for everything, it’s hard to accept that there are no drugs approved by the Food and Drug Administration (FDA) to treat behavioral symptoms in people with dementia.

Antipsychotics: Not the Answer

Yet medical professionals and nursing home staff continue to use antipsychotics as a way to alleviate behavioral symptoms. The vast majority of research findings state that these behavioral symptoms are typically a result of environmental factors.

Dementia care experts recommend modifying these factors as opposed to masking the behavioral symptoms with an inappropriate medication.

To better understand, we need to define some terms for us non-medical professionals:

Psychosis is a mental disorder characterized by a disconnection from reality.
Antipsychotics are a class of psychiatric medication primarily used to manage psychosis; in particular schizophrenia and bipolar disorder.
Antipsychotics along with antidepressants, ADHD drugs, anti-anxiety medications, and mood stabilizers are types of psychotropic drugs.
A psychotropic is a chemical substance that changes brain function and results in alterations in perception, mood, or consciousness.

So when these medications which are approved for “a disconnection from reality” are used to treat behavioral symptoms in dementia patients, they are being used as “off label.”

Off label use is when a medication is used to treat something for which it is not approved by the FDA.

The Best Friends Dementia Bill of Rights states that the person with dementia has the right to be free from psychotropic medications whenever possible. However, studies continue to say that these drugs are often inappropriately prescribed and used for too long.

Using medications instead of addressing and modifying the environmental cause of the behavior, almost always results in a decrease in the quality of life for the individual with dementia. Often times the person is sedated and their ability to enjoy their surroundings and loved ones is negatively impacted.

In 2005, the FDA issued a warning that people with dementia who are on antipsychotic medications face an increased risk of sudden death 1.6 to 1.7 times greater than those who take a placebo.

This is why it’s often said that antipsychotics should only be used as a last resort. The Alzheimer’s Society says, “People with dementia have frequently been prescribed antipsychotic drugs as a first resort and it has been estimated that around two thirds of these prescriptions are inappropriate.” Some will argue that the rates are higher in some countries such as the United States.

Unfortunately, while there are limited instances when the use is appropriate, the overuse makes it seem appropriate to the untrained family caregiver. These family members, who are under enormous pressure, want a quick remedy to relieve their loved one’s symptoms and return life back to “normal.”

They don’t necessarily understand the need to observe and identify why the behavior is occurring, and that by doing so they can modify the cause, meet their loved one’s need, and avoid medication.

Even if they do understand the need, they may not have the knowledge or skills to know how. So it’s essential that more medical professionals start leading by example when considering a course of action for treating a behavioral symptom.

Helping educate family members, as well as professionals, on the proper ways to approach this situation is critical to providing better care for our loved ones with dementia.

We need to work together and spread the word to change this gross misunderstanding and inadvertent abuse of people with dementia.

Check out my free guide, Introduction to Alzheimer’s Medications and “Off Label” Prescriptions, to help you better understand the medications used in Alzheimer’s and dementia care.

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