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.
Managing Dementia Behaviors-To medicate, or not to medicate?
Jennifer Fitzpatrick, MSW, LCSW, 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. Moderate stages of dementia introduce very challenging behavioral and psychological symptoms. Paranoia, agitation and sundowning symptoms often leave caregivers desperately seeking a reprieve, "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 can be scary: confusion, dizziness, incontinence and a decreased ability to move and speak are just a few of the potential consequences of antipsychotic use.
Although studies point to modest efficacy, 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 Benefits and Risks of Antipsychotics
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, an elder may move 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.
Weighing Dementia Treatment Options
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 patient's feelings is usually the 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 psychiatrist who can help them examine the advantages and drawbacks of antipsychotics and help them select the best course of action.
Source: National Institutes of Health, Antipsychotic Use in Dementia, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994396/