WARNING: Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. —Food and Drug Administration
And a new study published in the Journal of the American Medical Association (JAMA) reports that clinicians prescribe these drugs to roughly 25 percent of Medicare beneficiaries diagnosed with dementia.
That means one in four elderly Medicare beneficiaries with diagnosed dementia take pills known to carry serious risks, which can leave older adults drowsy and confused, unsteady on their feet and more prone to falls.
In the worst case, antipsychotics can even cause death, according to FDA warnings.
Clinicians were about twice as likely to prescribe psychotropics when there was no documented reason whatsoever than when there was one.
The study found doctors prescribed these drugs to over two-thirds of patients without any documented justification—no condition, symptom or circumstance that would justify prescribing the drugs—despite their known dangers. In other words, clinicians were about twice as likely to prescribe psychotropics when there was no documented reason whatsoever than when there was one.
“You would think it would be the opposite,” said Harvard Medical School’s Anupam Jena, a professor of health care policy.
No kidding.
The study’s senior author, Dr. John N. Mafi, was even more direct. Authorizing dangerous drugs without even so much as a purported justification to such a wide population of often helpless individuals can constitute, as he puts it, “inappropriate and harmful prescribing.”
These are “not trivial drugs,” he added. Some “actually have an FDA black box warning because they almost double the risk of death in patients with dementia.”
As people age, their ability to metabolize drugs changes, and they become more “susceptible to the toxicities of drugs,” Mafi explained. Older adults also tend to take multiple medications, increasing the risk of dangerous interactions.
None of this is new. None of it is secret. The risks of prescribing central nervous system–active drugs like antipsychotics and antidepressants to elderly dementia patients have been well-known and well-documented—as the study says—for “decades.”
It’s exactly why the FDA has required black box warnings disclosing as much on all antipsychotic drugs.
So… why do they keep being prescribed?
One neuropsychologist offers this rationale: “Patients with dementia are terminally ill.” He goes on to justify: “Medications that can help these patients feel comfortable rather than fearful and combative are extremely important. It is malpractice not to use medications to assist these patients.”
OK… so the fact that the person is at death’s door is justification to imperil them further with potentially lethal drugs on the pretext of making them “comfortable”?
In the 1984 world of psychiatry, it is malpractice not to endanger the patient.
That rustling sound you hear is Hippocrates (“do no harm”) turning over in his grave.
Dementia is merciless, agonizing for both patients and loved ones. This writer’s mother, with middle-stage Alzheimer’s, once took the car at 3 a.m. in her dressing gown, searching for a long-closed beauty parlor. On another occasion, his father, suffering from dementia, wandered into a busy street seeking an old friend.
There’s no denying the heartache and sense of hopelessness that comes from watching a formerly bright and intelligent soul decay before one’s eyes.
Families are overwhelmed. Caregivers are exhausted.
But the answer to their prayers does not lie in pumping known poisons into an already struggling body.
With the global antidepressants market projected to hit over $18 billion in 2027 and the antipsychotic drugs market targeted to reach $25 billion that year, it’s small wonder that the psychiatrists who prescribe them and the pharmaceutical companies that manufacture them might dismiss all questions with a cavalier “it’s terminal, so no worries.”
They’re paid to do so.
But if we’re going to operate on that logic, the label might as well state it plainly:
“Take twice daily. She’s going to die anyway.”
