Doctor Group seeks to Limit Antipsychotics use due to Harmful Side Effects by Ralph Teller

Antipsychotics are being prescribed when they shouldn't be causing serious health and social problems

Doctors are prescribing antipsychotics, including antidepressants, to children, adults and the elderly at alarming rates, when they shouldn't be, causing (i) signficant health problems to a wide segment of the population and (ii) added social and financial stress to the general community.

In recognition of this over precribing problem, the American Psychiatric Association's (APA) has issued a list of questionable uses of antipsychotic medications. This list is part of a broader campaign called Choosing Wisely to educate patients and doctors about unneeded and possibly harmful medical treatments and tests. Here is what the APA is recommending:

1. Don’t prescribe antipsychotic medications to patients for any use without an appropriate clinical diagnosis. The APA notes that metabolic, neuromuscular and cardiovascular side effects are common side effects of antipsychotic medications for any use. The APA is recommedning doctors do a thorough initial evaluation to ensure that the use of antipsychotics is clinically warranted. The APA notes these antipsychotics have been more widely used for patients ranging from unruly nursing home residents to children with aggressive behaviors or attention deficit hyperactivity disorder and is trying to move doctors away from prescribing the use of antipsychotics to treat these general symptoms.

2. Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults. The APA indicates there is inadequate evidence for the efficacy of antipsychotic medications to treat insomnia.

3. Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders. The APA notes that recent research indicates that use of antipsychotic medication in children has nearly tripled in the past 10 to 15 years, and this increase appears to be disproportionate among children with externalizing behavior disorders (i.e., rather than schizophrenia, other psychotic disorders and severe tic disorders). Evidence for the efficacy and tolerability of antipsychotic medications in children and adolescents is inadequate. The APA notes concerns about weight gain, metabolic side effects and a potentially greater tendency for cardiovascular changes in children than in adults.

4. Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia. Behavioral and psychological symptoms of dementia are defined as the non-cognitive symptoms and behaviors, including agitation or aggression, anxiety, irritability, depression, apathy and psychosis. Evidence shows that risks (e.g., cerebrovascular effects, mortality, parkinsonism or extrapyramidal signs, sedation, confusion and other cognitive disturbances, and increased body weight) tend to outweigh the potential benefits of antipsychotic medications in this elderly population.

5. Don’t routinely prescribe two or more antipsychotic medications concurrently.The APA motes that the evidence for the efficacy and safety of using multiple antipsychotic medications is limited, and risk for drug interactions, noncompliance and medication errors is increased.

A purpose of the Choosing Wisely campaign is to encourage physicians and patients to have the important conversations necessary to ensure the right care is delivered.

It is encouraged you have the conversation with your doctor about (i) the dangerous side effects of antipsychotics and (ii) what diet, exercise and other environmental changes can be made (instead of antipsychotics) in treating mood or behavioral disorders of you or your child.

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