Brain Mind Center

Antipsychotic Drugs and Seniors

There is growing problem with inappropriate and excessive drug prescription to people over the age of 65. Physicians routinely prescribe antipsychotic drugs to their aging patients; the benefits are doubtful and the negative effects are well established. In a review of physicians attitudes and prescribing practices, Damestoy et al stated:"The inappropriate use of medications by elderly patients has become a public health concern because of its prevalence and its potential impact on patient autonomy physicians were unanimous in their view of the aging process as a very negative experience.

In April 2010, the drug company AstraZeneca agreed to pay $520 million to settle US government allegations that it illegally promoted the antipsychotic drug Seroquel (quetiapine fumarate) as a treatment for medical conditions for which it had not received approval such as Alzheimer's disease, depression and sleeplessness. AstraZeneca's total sales of Seroquel reached $4.87 billion in 2009.

Fick et alstated: "A literature search will uncover articles that describe the toxic effects of medications and drug-related problems for older adults. It has been conclusively demonstrated that the toxic effects of medications and drug-related problems can have profound medical and safety consequences for older adults, with enormous economic consequences on the healthcare system. If medication-related problems were ranked as a disease by cause of death, it would be the fifth leading cause of death in the United States. Therefore, the prevention and recognition of drug-related problems in elderly patients is one of the principal healthcare quality and safety issues for this decade. An extensive survey of the literature was conducted of all relevant medications used in elderly patients. This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. "

Some of the drugs prescribed are tranquillizers and sleeping pills that add to memory loss and confusion, effects that are easily ignored in the elderly. Antipsychotic drugs are potent and harm elderly patients. These drugs will not correct aberrant behavior, improve cognition or memory but disable and further damage an already compromised brain. Patient demand has always driven the prescription drug industry to produce more chemicals and to encourage physicians to prescribe these chemicals. A well trained physician will understand that psychotropic drugs are mostly useful for brief interventions and that long-term use is usually not desirable. Patients become dependent on psychotropic drugs and many demand renewed prescriptions over many years. Damestoy stated: "Many of the (elderly) patients had been using psychotropic medication for a long time, some for as long as 20 years. Patients with a strong attachment to anxiolytic drugs become demanding and difficult when their use of psychotropic drugs was questioned."

The path of least resistance for physicians is to enquire little and renew prescriptions automatically. In a study of 224 patients with a diagnosis of probable Alzheimer's disease, that risk of deterioration was significantly higher among patients who were taking antipsychotics or sedatives compared with those who were not on any drugs. Patients who were taking both antipsychotics and sedatives had the highest risk of rapid deterioration.

Antipsychotic drugs were developed to treat schizophrenia, a disease of young people. The atypical antipsychotics - clozapine, olanzapine, quetiapine and risperidone have all been used to treat elderly patients, especially those with dementia. There is no evidence that any of these drugs will alleviate dementia in any way. They are used as "chemical straight jackets to immobilize nursing home residents. Among the problems created by these drugs are Parkinsons disease, weight gain, hyperglycemia and diabetes 2. Janssen-Ortho, the company that markets Risperdal (risperidone), issued drug safety information bulletin linking the drug to increased risk of strokes in elderly patients. Since there is significant doubt that this drug should be used in any elderly patients, the increased risk of diabetes and stroke is a definitive contraindication. The strength of the association between antipsychotics and diabetes varies. A number of reports implicate chlorpromazine, clozapine, and olanzapine. An Ontario study involving 20,000 patients in nursing homes revealed that 25% of the residents are prescribed antipsychotic medications within the first year of admission. I suggest a more appropriate level of use would be less than 1% of residents.

The Institute for Clinical Evaluative Sciences, in Toronto, Ontario, Canada carried out a surveillance study of antipsychotic drug use in adults with dementia 66 years of age or older.. The records of 20,682 adults living in the community and 20,559 adults living in a nursing home were examined. The most commonly prescribed atypical antipsychotics were risperidone, olanzapine, and quetiapine, and the most common conventional antipsychotics were haloperidol, loxapine, and thioridazine hydrochloride. They found that patients given antipsychotic drugs were up to 4 times more likely to be hospitalized or die within 30 days. They warned that serious side effects occur shortly after starting the drug.


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