Antipsychotic medications are used to control psychoses such as schizophrenia, but they can also be used to treat behavioral disturbances such as suspicion and paranoia associated with Alzheimer’s disease.
Antipsychotic drugs, although not approved by the FDA for treatment of patients with dementia, are still prescribed and their use has increased substantially in the past 20 years or so. According to the Center for Medicare and Medicaid Services, nearly a third of all nursing home residents are prescribed antipsychotic medication. Recent research in the UK has highlighted the danger of using antipsychotic drugs in older people with dementia and 1800 deaths have been linked to their use to calm agitated and aggressive patients.
Antipsychotic drugs do have a valid role in treating behavioral symptoms associated with Alzheimer’s and other types of dementia and as long as they are used carefully and monitored closely they are an important treatment option, as this sharepost from Dorian Martin attests in Another Side to the Discussion of Anti-Psychotic Drugs - My Mother’s Experience. However, their use does cause a lot of caregiver anxiety and the changes that can occur in a loved one’s behavior needs careful discussion with doctors in charge of their care.
Types of Antipsychotic Medications
Antipsychotic medications include the older conventional antipsychotics medications such as chlorpromazine (Thorazine), thioridazine (Melleril), haloperidol (Haldol) and the newer atypical antipsychotics such as quetiapine (Seroquel), risperidone (Risperdal) and olanzapine (Zyprexa).
Ongoing Concerns about Antipsychotic Drug Use in the Elderly
The FDA, exercising its new authority under the Administration Amendments Act 2007, now requires manufacturers to put a boxed warning on the labels of conventional and atypical antipsychotic drugs stating that their use is associated with increase risk of death in older people.
Medications can be very good for managing behavioral symptoms. Some types of anti-anxiety medications can treat agitation and aggression short term, and antipsychotic medications are still being prescribed to try to control aggression that can result from suspicion and paranoia.
Side Effects of Antipsychotic Medication
Signs of overmedication, side effects or drug interactions include; sleepiness, increased confusion, reduced mobility and unsteadiness, a shuffling gait, reduced communication, an increased incidence of urinary and fecal incontinence. In very severe cases the tranquillizing effects of the medication can lead to depression of respiration and heart rhythm abnormalities
Extrapryramidal Side Effects of Antipsychotic Medication
Sometimes side effects to antipsychotic medication are very severe and can cause profound physical problems. Antipsychotics, especially when used long term, can damage the extrapyramidal motor system, a neural network located in the brain that is involved in the coordination of movement. Extrapyramidal symptoms can begin within a few hours, days or weeks or even years after commencing treatment with an antipsychotic medication. Tardive Dyskinesia describes symptoms that may result from antipsychotic medications.
Symptoms of extrapyramidal side effects include; restlessness, shuffling gait, tremors and rigidity, muscle contractions, mask like face, involuntary movements, involuntary movement of the eye (called oculogyric crisis), drooling, increased heart rate and delirium. Symptoms can be very distressing and frightening.
Importance of Close Monitoring of any Side Effects of Anitipsychotic Medication
Drug reactions and/or interactions are, unfortunately, common among those with Alzheimer’s. It is very important that a combination of drug and non-drug therapies are used to treat anxiety and aggression. A chemical cosh using antipsychotic drugs is not desirable for anyone, let alone frail elderly people with dementia.
Antipsychotic medication should only be used short term and their use be evaluated on a regular basis. If you suspect your friend or relative is suffering side effects or over medication then you need to get a doctor to see them urgently. It is very important that you are involved with the decision, so you understand the therapeutic goals in using the drug and can act as advocate for your vulnerable loved one with dementia.
More Information on Antipsychotic Medication and Dementia