Antipsychotics that Hikes Mortality Risk Among Elderly Revealed

A retrospective study involving more than 33,000 elderly patients showed that all antipsychotics do carry some mortality risk, and this risk depends on the type of the medication.

Antipsychotics are medications designed primarily to manage psychotic symptoms of medical conditions such as schizophrenia, bipolar and delusional disorders. They are also used as ‘off-label’ medications for depression, mood disorders, Tourette syndrome and dementia among elderly patients.

It showed that the antipsychotic with the highest mortality risk is haloperidol, also known as Haldol and Haldol Decanoate. The second was Risperidone (Risperdal) and followed by Olanzapine, Valproic Acid and its derivatives and Quetiapine (SEROquel).

Researchers used data from the US Department of Veterans Affairs, choosing those records of patients older than age 65 and who had dementia.

According to the results of the study, 6 month mortality rates were as follows:

Haloperidol                             20%

Olanzapine                              12%

Risperidone                             12.5%

Valproic acid and derivatives 9.8%

Quetiapine                               8.8%

 

It appears that, in this case Haloperidol, highest risk of death occurred within 30 days from the start of initial administration. After this period, the risk falls down significantly. The results did not surprise the researchers, and it confirmed results of previous studies. Haloperidol is noted for its strong and early onset of side effects. It is to note that the study group is composed of elderly individuals with dementia. And those who took Haloperidol are often older and have more co-morbidities.

The result for quetiapine is more surprising, as the medication is associated with increased Parkinsonian symptoms.

 

Risks for benefits should be carefully considered

The researchers said that their study should not be a reason for people and doctors to shun away from antipsychotics.  It is the only treatment for some medical conditions, and for symptoms like agitation, aggression or psychosis. However medical providers should carefully weigh benefits and risks.

Although antipsychotics are often used as ‘off-label’, there are not good alternative drugs in most cases. They are especially effective if coupled with nonpharmacological treatments. Antipsychotics also work well for short-term management for symptoms, giving them only as needed.

Previous randomized control trials on antipsychotics show that Risperidone and Olanzapine are best options in regards to evidence of effectiveness.

The study is supported by US National Institute on Mental Health (NIMH) and is published in this month’s issue of American Journal of Psychiatry.

 

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