Antipsychotics for dementia causes more harm, finds study

Antipsychotic use in dementia carries a wider range of risks than previously recognized, especially in the early stages of treatment, emphasizing the need for caution. Despite safety concerns, they are commonly prescribed for behavioral and psychological symptoms such as apathy, depression, aggression, and anxiety. Regulatory warnings highlight increased risks of stroke and death, but evidence of other adverse outcomes is less clear.

In the study, researchers examined potential adverse outcomes linked to antipsychotic use in individuals with dementia. They analyzed data from 173,910 dementia patients, of whom 35,339 were prescribed antipsychotics after diagnosis. The study looked at outcomes including stroke, blood clots, heart attack, heart failure, irregular heart rhythm, fractures, pneumonia, and acute kidney injury. The most commonly prescribed antipsychotics were risperidone, haloperidol, and olanzapine, which accounted for almost 80% of all prescriptions.

The results showed that compared to non-use, antipsychotic use was linked to higher risks for all outcomes except ventricular arrhythmia. For instance, within the first three months of treatment, antipsychotic users had higher rates of pneumonia (4.48% vs. 1.49% for non-users), which increased to 10.41% vs. 5.63% at one year. Antipsychotic users also faced increased risks of acute kidney injury (1.7-fold), stroke, and venous thromboembolism (1.6-fold) compared to non-users. Risks were highest during the first week of treatment, especially for pneumonia.

“Antipsychotics are associated with a considerably wider range of serious adverse outcomes than previously highlighted in regulatory alerts, with the highest risks soon after starting treatment, and are therefore of direct relevance to guideline developers, regulators, clinicians, patients, and their carers. Any potential benefits of antipsychotic treatment need to be weighed against risk of serious harm and treatment plans should be reviewed regularly, they add. The study findings will equip healthcare professionals with more nuanced data to help guide personalized treatment decisions,” said the study authors. 

Reference: Pearl L H Mok, Matthew J Carr, Bruce Guthrie, et al; Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study; The BMJ; https://doi.org/10.1136/bmj-2023-076268