Antipsychotic drugs make dementia patients worse

It's a fairly common practice to use antipsychotic drugs to calm the outbursts, combative behavior, and agitation in dementia patients - a little too common, if you ask me. Sales of these drugs have tripled in the last eight years - from $4 billion in 2000 to $13.1 billion last year.

Risperdal is the most frequently prescribed antipsychotic drug in the U.S. And while the FDA has approved it for the treatment of schizophrenia, it's being prescribed to other patients "off label" (i.e., prescribing it to treat a malady for which the drug was not originally intended) for dementia patients.

What's maddening is that doctors write these prescriptions and dole out these drugs in spite of a virtual Niagara Falls of bad press and FDA warnings about their dangers. The FDA has ordered that the newer antipsychotics be slapped with the dreaded "black box" label warnings of an increased risk of death (clearly, the FDA's warnings are never dreaded enough).

A 2006 study of Alzheimer's patients found that antipsychotic drugs provided NO SIGNIFICANT IMPROVEMENT over placebos in treating the delusions and aggression that accompanies that disease. What's more, several states are currently suing the makers of some of the top-selling brands of antipsychotics on charges of false and misleading marketing.

And yet, in the face of all of the warnings that antipsychotics can be both ineffective and dangerous, over-prescribing and abuse of these medications is still going on. Why?

Sadly, most of these prescriptions can be traced to nursing home patients, where as many as one-third of all patients are regularly given these drugs.

One doctor who works in nursing homes says that though doctors are encouraged to prescribe antipsychotics only as a last resort, "Many physicians are absent without leave in the nursing home and don't take an active role in the assessment of the patient."

Another problem is that insurance usually doesn't pay for the attentive, hands-on psychosocial therapy that often truly benefits dementia patients. As a result, short-staffed nursing homes often take the easy way out and prescribe sedatives and antipsychotic drugs to dementia patients - regardless of the side effects.

The saddest part of all is that many cases of dementia are best alleviated with a little TLC on the part of care givers - drugs are often not required at all. Doctors note that in randomized trials of antipsychotic drugs, as many as 30 to 60 percent of the placebo patients improved. Dr. Dillip V. Jeste, a professor of psychiatry and neuroscience at the University of California calls those statistics "mind boggling."

"These severely demented patients are not responding to the power of suggestion. They're responding to the attention they get when they participate in the trial. They receive both TLC and good general medical and humane care, which they did not receive until now," Jeste says. "That's a sad commentary on the way we treat dementia patients."

I couldn't have said it better myself. But as long as there is laziness on the part of nursing home staffs and a buck to be made by Big Pharma, you'd have to be demented to think that this situation will change any time soon.