By the National Institute of Mental Health
Despite known risks of serious side effects, especially in older adults, the fraction of seniors treated with antipsychotic medications increases with age, researchers have found. Such medications may be appropriate for treating certain mental disorders, yet more than three-quarters of seniors receiving an antipsychotic prescription in 2010 had no documented clinical psychiatric diagnosis during the year. Further, among those who did have a diagnosed mental disorder and/or dementia, nearly half of the oldest patients had dementia, regardless of FDA warnings that antipsychotics increase mortality in people with dementia.
Known side effects of antipsychotic medications include metabolic problems and weight gain. For older adults receiving antipsychotics, the risks of dangerous side effects such as strokes, fractures, kidney injury, and mortality are increased. Despite concerns, researchers found that the percentage of people receiving an antipsychotic prescription in 2010 increased with age after age 65. The percentage with an antipsychotic prescription was approximately twice as high among people 80 to 84 as among those age 65 to 69. The research was funded by the National Institute of Mental Health (NIMH), which is part of the National Institutes of Health.
Mark Olfson, M.D., M.P.H., of the Department of Psychiatry, College of Physicians and Surgeons and Columbia University and New York State Psychiatric Institute, and colleagues Marissa King, Ph.D., Yale, and Michael Schoenbaum, Ph.D., NIMH, report their findings on today in the Journal of Clinical Psychiatry.
The research team looked at antipsychotic prescriptions filled between 2006 and 2010 and found that among older adults who had used antipsychotics, around half had used the drugs in excess of 120 days in the year.
“In light of these risks, the FDA has issued warnings of increased mortality regarding antipsychotics in elderly patients with dementia, particularly for ‘atypical’ (or 2nd generation) antipsychotics” said Michael Schoenbaum, Ph.D., senior advisor for mental health service, epidemiology and economics at NIMH and one of the co-authors of the report. “Nevertheless, around 80 percent of antipsychotic prescriptions among adults 65 and older were for atypical medications.”
“Typically, psychiatrists are more familiar with the properties of antipsychotic medications,” continued Schoenbaum. “However, about half of the people age 65 to 69 and only one fifth of those age 80 to 84 who were treated with antipsychotics received any of these prescriptions from psychiatrists.”
The FDA has approved antipsychotics for treatment of certain mental disorders, particularly schizophrenia and bipolar disorder, yet the majority of the people in the study had no such diagnosis. Among people aged 70 and older who received an antipsychotic in 2009, only around 20 percent had a recorded mental disorder or dementia diagnosis during the year. Among that 20 percent, many had a dementia diagnosis: 25 percent ages 70-74, 37 percent ages 75-79, and 48 percent ages 80-84.
“The results of the study suggest a need to focus on new ways to treat the underlying causes of agitation and confusion in the elderly,” said lead author Mark Olfson. “The public health community needs to give greater attention to targeted environmental and behavioral treatments rather than medications.”
Olfson, M., King, M., Schoenbaum, M. Antipsychotic Treatment of Adults in the United States. Journal of Clinical Psychology (in press)