How Antipsychotic Drugs Help with Dementia

By American Geriatrics Society (AGS)

These medicines were initially developed to treat people who suffer with severe mental health conditions like schizophrenia. They were the first pills to help rid patients of disturbing symptoms like delusional ideas, paranoia, and hallucinations. These pills enabled sufferers to live more normal lives in the community rather than be admitted into asylums to be forgotten about.

As a result of a patient’s actions, antipsychotics may be prescribed to treat hallucinations and delusions that may develop in more advanced dementia as well as to settle aggression and agitation. However, in 2008, the FDA issued a black box warning (that is, a serious warning to all healthcare professionals), stating that all antipsychotic medications are associated with an increased risk of death in dementia patients being treated for agitation or psychotic symptoms including delusions, paranoia, and hallucinations.

The risk of death in dementia patients taking these drugs was 1.6 to 1.7 times that of dementia patients taking a placebo. Most deaths were due to heart failure, sudden death, or infection such as pneumonia. The FDA instructs physicians who prescribe antipsychotic medication to dementia patients to discuss this risk of increased mortality with the patients’ families and caregivers.

Understanding how antipsychotic drugs work

Two main groups of antipsychotic medications exist, separated chronologically into older or conventional antipsychotics (such as chlorpromazine and haloperidol) and newer or atypical antipsychotics (like risperidone and olanzapine). The newer drugs, developed since the 1970s, have fewer side effects than those made earlier.

Antipsychotics work on neurotransmitters. They affect serotonin, noradrenaline, and acetylcholine, but the majority of their action comes from their particular role in blocking dopamine.

Knowing when doctors prescribe antipsychotics

Every effort should be made to first address other potential causes of a patient’s behavioral issues. Antipsychotic medications should only be used to treat specific disturbances that don’t respond to environmental modifications or reductions in other medications. They shouldn’t be used as a de facto chemical restraint.

Doctors keep these drugs in reserve and use them only when people have really serious and distressing behavioral or psychological symptoms. However, as per the FDA warning, these drugs should only be used after the physician has reviewed risks and benefits with the patient’s family and caregivers and only if they agree to that use. Patients on these drugs must be monitored closely for severe side effects.

Being aware of the side effects and risks

The side effects of antipsychotics are quite wide ranging because the drugs affect so many different neurotransmitters in the brain. Dopamine is involved in movement (people with Parkinson’s disease have low levels in their brains), so shakiness (tremor), muscle stiffness, and unsteadiness are common side effects especially with the older conventional antipsychotics. These drugs can cause abnormal uncontrollable movements of the mouth and tongue called tardive dyskinesia. They can cause drowsiness and a greater risk of falling. Antipsychotics can also cause headaches, weight gain, diabetes, and stomach upset.

Antipsychotics should never be given to people with Lewy body disease. Half of people with this condition have a severe sensitivity to antipsychotics that can worsen symptoms and even, in some cases, be fatal.