In a remarkable turn, the American Psychiatric Association recently advised physicians and patients to question five common antipsychotic prescribing practices. Four of the five warnings from the APA related to the use of antipsychotics for “treating” dementia:
1) Don’t use antipsychotics as the first choice to treat dementia. Non-drugging options based on remedying the patient’s underlying distress or discomfort achieve better results for patients with dementia and do not have the serious side effects of antipsychotic drugs.
2) Don’t use antipsychotics as a first-line intervention for insomnia. Many people with dementia receive antipsychotics to “calm” them or help them sleep. This practice is not supported by clinical evidence.
3) Don’t use two or more antipsychotics concurrently. Unfortunately, the use of multiple antipsychotics for people with dementia happens, exacerbating the lethality of the drugs and reducing quality of life.
4) Don’t use antipsychotics for any indication without an appropriate evaluation. In nursing homes, the vast majority of added drug prescriptions are made by doctors telephoning or faxing their orders. Without personally observing the resident and assessing the potential underlying causes of behavior, doctors cannot be sure that a prescription is warranted.