Subject:
Antipsychotics

Short Description:
More evidence that antipsychotics are dangerous in dementia

Background:
In 2005, the FDA issued a health advisory saying that antipsychotics appear to increase the risk of death in elderly patients with dementia. That advisory was based on data from placebo-controlled trials of antipsychotics conducted by industry. Now, a new study based on a completely different, and much larger, dataset, appears to confirm these dangers. Researchers used comprehensive medical records available through Canada’s health system to identify all elderly patients treated for dementia from 1997 to 2002 in the province of Ontario. A total of 27,259 patient records were examined. The researchers found that after 30 days of taking atypical antipsychotics, patients had a mortality rate of 3.9%, while matched patients on no antipsychotics had a mortality rate of 2.7%, meaning that atypicals increased the risk of early death by a factor of 1.55. Researchers had enough data to compare conventional agents vs. atypicals, and found that conventionals were riskier than atypicals by a factor of about 1.25 (Gill SS et al., Ann Intern Med 2007;146:775-786).

TCPR's Take:
The relative risk looks large, but the absolute risk is only 1.2%, meaning that atypicals would cause roughly one excess death out of each 100 patients treated with atypicals. The question is whether this small risk is overshadowed by the quality-of-life benefit agitated patients derive from being on antipsychotics. Many would argue that antipsychotics are worth this risk.

For more on this topic, see The Carlat Geriatric Psychiatry Report.