Should Someone With Alzheimer’s Be Given Antipsychotics?

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Should a loved one with Alzheimer's be given antipsychotics?

Many caregivers face this loaded question, which seems to have no straight answer.

The Federal Drug Administration (FDA) hasn't approved antipsychotic medications for formal use in people with Alzheimer's, but doctors are allowed to issue prescriptions for off-label use (when a drug is prescribed for a disease it wasn't officially authorized to treat).

Antipsychotics, such as: Seroquel, Abilify, Risperdal, Zyprexa and Haldol may reduce agitation, aggression and anxiety in people suffering from dementia, but they can also pose a significant threat to a senior's health.

To medicate, or not to medicate?

Jennifer Fitzpatrick, M.S.W., L.C.S.W., an aging and dementia expert who consults for the Alzheimer's Association, admits that there are pros and cons to using antipsychotics to alleviate Alzheimer's symptoms.

"For some patients, these medications help manage behavior and can give caregivers a break," she says, "But the typical senior is probably already on other medications. Adding another one to the mix could result in unwanted side-effects."

These additional effects are scary: confusion, dizziness, incontinence and a decreased ability to move and speak are just a few of the potential consequences of antipsychotic use.

Much of the research into the effects of antipsychotics on people with Alzheimer's and other dementias lands firmly in the negative camp.

In 2005, the FDA issued a warning that people with dementia who are on certain antipsychotic medications face an increased risk of sudden death. Research has backed these claims, with some studies finding the risk of death may be doubled for seniors taking certain mood-altering prescriptions.

The lesser of two evils?

For some seniors, the benefits of antipsychotics may outweigh the risks.

A recent study found that dementia-stricken seniors who have a positive reaction to risperidone (Risperdal) were better off sticking with the medication as opposed to going off it after the recommended three to six months. When they stopped taking the drug, most elders experienced a return of their anxiety and agitation.

Antipsychotics may also be the key to making sure a senior stays calm enough to be cared for at home.

Once a person with Alzheimer's begins to exhibit extreme behavioral problems, a caregiver may no longer be able to handle taking care of them. In these situations, the elder moves into a nursing home, where antipsychotic use is prevalent .

More than 88 percent of Medicare-funded antipsychotic medications prescribed in nursing homes are for people with dementia, according to the Department of Health and Human Services (HHS). About half of these prescriptions were for unnecessarily high dosages.

A treatment of last resort

Fitzpatrick feels that antipsychotics should only be sought when all other possible treatment avenues have been pursued. She suggests caregivers first use behavioral strategies to help their loved ones cope with feelings of anxiety and paranoia.

"When it comes to hallucinations or delusions, validating the feelings is a best practice," she says.

This means avoiding the instinct to argue.

Don't try to convince a loved one that what they're seeing or hearing isn't real—it won't work. Your goal should be to help a senior feel safe without openly disagreeing with a vision that is very real to them.

Another approach advised by Fitzpatrick is distracting an agitated loved one with an activity that they enjoy doing.

If you feel that your loved one might benefit from treatment with antipsychotics, Fitzpatrick advises seeking out the expertise of a geriatrician or geriatric psychologist who can help them examine the advantages and drawbacks of antipsychotics and help them select the best course of action.

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3 Comments

There is an additional concern not mentioned in this article that exists regarding giving anti-psychotic medications to people with dementia. People suffering with Lewy Body Dementia (LBD) can experience severely negative consequences if given anti-psychotics such as Haldol. This is particularly worrisome because studies conducted by the Lewy Body Dementia Assn. have shown that approx. 3/4 of LBD patients are initially mis-diagnosed as having Alzheimers, Parkinsons or a psychotic illness.

Lewy Body Dementia is a progressive brain disease and the second most common cause of neurodegenerative dementia after Alzheimer’s disease. Lewy body dementia is a ‘spectrum disorder,’ meaning it can occur alone or in
combination with Parkinson’s disease, or co-exist with Alzheimer’s disease.

LBD symptoms include dementia plus any combination of: unpredictable levels of cognitive abilities, attention and alertness, changes in movement or gait, hallucinations, a sleep disorder where people physically act out their dreams, and severe medication sensitivities.

For more information about LBD, visit the Lewy Body Dementia Assn.'s website: www.lbda.org .
Very interesting comment on LBD, my father was diagnosed with dementia/Alzheimer's. He was prescribed Respiridal even though the doctor qualified it by telling us that patients with dementia passed faster while taking antipsychotics. I was definitely not happy about that. But my brother wanted to try it because my father was seeing spiders and other flying objects all the time. After some research I found that one of the other meds he was taking for sleep were causing him to hallucinate and the Respiridal was making that worse. I stopped both of those meds and put him on a supplement for mental function a precursor to Glutathione and he is doing great. No more hallucinations, no more spiders and no more confusion. He is so much better I wonder why he was given those meds in the first place?????
Natural first us always best. Doctors are to eager to apply the quick-fix prescription drug without even knowing or understanding the history of individual patients. My 92-year-old dad went into the ER and the first thing the doc did was give him an antipsychotic. It was horrible. My father had never taken a prescription drug in his life! That dolt almost killed him; he had to be transferred to an interim facility to rehabilitate from the drugs he was given. Once the drugs were out of his system, a course of mega vitamin therapy got him back to being himself. Without medical intervention, he lived to be 97. No thanks to MDs.