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Early warnings lowered use of antipsychotic
medications for dementia, study finds
February 8, 2011. — As loved ones with dementia
disappear into symptoms of aggression,
agitation or delusions, families are left
with few good medical solutions. A new
generation of antipsychotic medications
gained popularly in the 1990s because they
avoided side effects such as Parkinson's
syndrome associated with conventional
antipsychotic medications used to treat
dementia.
But a new study led by University of Michigan
and VA Ann Arbor Healthcare System
researchers shows the use of these
second-generation medications began to
decline significantly in 2003, years ahead
of a "black box" warning from the Food and
Drug Administration in 2005 – the strongest
type of warning issued by the FDA.
Helen C. Kales, M.D., associate professor of
psychiatry at the University of Michigan
Medical School and researcher at the VA Ann
Arbor Healthcare System, says this shows
that emerging understanding of the
medications' increased risk of diabetes and
stroke was taken seriously.
Prescriptions of the second-generation
medications dropped off more steeply after
the black box warning, which shows that it
too had an impact, says Kales, the study's
lead author.
"If you look at the history of black box
warnings, sometimes they have an effect and
sometimes they do not," she says. "When the
warning was issued about children taking
antidepressants, we saw a big drop in use,
but in other cases there wasn't much change.
In this case, providers appeared to be
responsive."
The analysis, published Feb. 7 in the Archives
of General Psychiatry, drew from data on
more than 250,000 patients from national
Veterans Affairs registries maintained in
Ann Arbor. It's the only study on the topic
to adjust for demographic shifts, the
article notes.
While the number of dementia cases among VA
patients 65 and older more than tripled from
30,000 in 1999 to 100,000 in 2007 as World
War II and Korean War veterans aged, the
study found the use of second-generation
antipsychotic medications declined.
Prescriptions fell from about 18 percent of
patients to 12 percent.
"Without adjusting for the aging population,
you wouldn't see that the decline started
before the warning was issued," Kales says.
The study authors do not pinpoint a single
reason for the decline during the period
before the warning, but observed that
doctors and media outlets were starting to
take note of fatal risks associated with the
class of medications, which includes
Olanzapine (Zyprexa), Riperidone (Risperdal)
and Quetiapine (Seroquel).
Despite the drugs' increased risks and
sometimes limited efficacy, doctors and
desperate families find themselves with few
good alternatives, Kales notes.
"The take-home message is that families need to
take a measured approach and have a
conversation with their doctor about the
potential benefits and risks," she says.
"The behaviors associated with dementia can
put a huge burden on families and
unfortunately, there's no magic bullet."
