In a 2005 public health advisory, the FDA warned that antipsychotics appear to increase the rate of mortality in elderly patients with dementia. The implication is that we should discontinue such agents in this population when possible. But does this actually decrease the mortality risk? A recent randomized trial attempted to answer this question. In this study, 165 patients with dementia who were already taking antipsychotics were randomly assigned to either continue their antipsychotic regimen or switch to placebo for one year. During that year, more of the patients taking an antipsychotic died of any cause (30%) than did those taking placebo (23%). After a year, the randomized treatments were dis- continued and patients were placed on treatment as deemed appropriate by their physicians. When the original two groups were compared after three and a half years (42 months), there were significantly more survivors from the placebo group (53%) than from the antipsychotic group (26%) (Ballard C et al., 2009 Lancet Neurol 2009;8:151-157).
TCPR’s Take: The researchers did not track which medications were received by patients after the initial 12-month trial, so some of the patients in the placebo group likely restarted antipsychotics, while some patients who initially took antipsychotics may have discontinued them. That said, the group receiving antipsychotics during the 12-month trial quite likely had a greater cumulative exposure to the drugs than did the placebo group. Prior research has suggested minimal benefits and increased risk of mortality for antipsychotics in treating dementia (Schneider et al., 2006 Am J Geriatr Psychiatry;14:191-210). The bottom line is that we should minimize demented patients’ exposure to antipsychotic medications.
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