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Warning on safety of antipsychotic drugs in older people

Researchers are warning that medicines sometimes prescribed to older people with psychological illnesses or behaviour problems could put them at risk of harm.

BMJ Group News

What do we know already?

demential screening at 75 proposed

Antipsychotic drugs are medicines that can help people with serious mental illnesses, like schizophrenia and bipolar disorder. They can improve some of the symptoms of these illnesses, like feeling agitated, having disorganised thoughts, or behaving unusually. They can also help prevent a relapse.

Antipsychotic drugs are sometimes used if people have mental illnesses that share symptoms with schizophrenia and bipolar disorder. For example, antipsychotics can sometimes help people with dementia and Alzheimer’s disease who have symptoms like feeling agitated or behaving aggressively. Antipsychotics are not approved to use for dementia, but some people find they can be helpful.

However, taking antipsychotics can cause dangerous unwanted effects, particularly for people aged 40 and older. Studies have shown these drugs increase the risk of heart problems or a stroke. Antipsychotics also increase the risk of less serious but unpleasant side effects like muscle problems and feeling sedated or numb.

This study looked at 332 people aged 40 and over with schizophrenia, mood disorders, post-traumatic stress disorder, and dementia. Everyone in the study took one of four antipsychotics ( aripiprazole, olanzapine, quetiapine, or risperidone) for two years. The researchers checked on their side effects at the start of the study, after six weeks, and then every 12 weeks after that.

What does the new study say?

Overall, 24 in 100 people taking antipsychotics had serious side effects. These included death, needing to go to hospital for emergency treatment, or having to stay in hospital for treatment. No one drug was more likely to cause serious side effects than any other.

Some 50 in 100 people had less serious side effects. There was a difference between drugs in how likely people were to have less serious side effects.

  • Forty-six in 100 people taking risperidone had less serious side effects
  • Forty-nine in 100 people taking aripiprazole had less serious side effects
  • Seventy-three in 100 people taking olanzapine had less serious side effects
  • Seventy-eight in 100 people taking quetiapine had less serious side effects

Thirty-seven in 100 people taking antipsychotics developed a condition called metabolic syndrome. This condition puts people at higher risk of heart disease and diabetes, among other illnesses.

How reliable is the research?

This is a fairly small study, so we have to be cautious about what conclusions we draw from the results. But it does support the findings of larger good-quality trials and reviews showing that antipsychotic drugs can have serious side effects, especially if they are used for dementia and other illnesses for which they have not been approved.

What does this mean for me?

These results back up findings from previous studies, and suggest antipsychotic drugs can have serious and sometimes dangerous side effects for people over 40. The researchers stress that people taking these drugs shouldn’t stop taking them without first discussing their concerns with their doctor. There are other treatments that can help, such as behavioural therapy. Your doctor will be able to help you find out if these treatments are available in your area.

Published on November 29, 2012

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