The facts about anti-psychotic drugs

If your loved one has been prescribed anti-psychotic drugs to help deal with symptoms of dementia you might want to know more about them. Find out the essential facts about anti-psychotic drugs

In a nutshell

Anti-psychotic drugs were developed to treat serious mental health conditions such as schizophrenia, but they can also help control some of the most challenging symptoms of dementia such as aggression, hallucinations and delusions, by acting as a sedative.

Three facts worth knowing

1. Only one anti-psychotic drug – risperidone – is licensed to treat the symptoms of dementia in the UK.

2. However doctors can prescribe other anti-psychotic drugs 'off licence' if they wish, which means they can still prescribe them for the treatment of dementia if they feel it is necessary. Other commonly used anti-psychotics include haloperidol, aripiprazole, olanzapine and quetiapine.

3. Anti-psychotics are usually given as a tablet or liquid, but can also be injected into muscles for a longer-lasting effect.

What drugs are there?

Key drugs: Risperidone, Haloperidol
Used for: Aggression, psychosis, severe agitation or anxiety
Taken as: Tablet, liquid or injection

Here's the science

Anti-psychotics calm brain activity by dampening down dopamine, a chemical in the brain. Too much dopamine in the brain can lead to hallucinations, delusions and confused thinking.
The drugs were first developed in the 1950s, these are called 'first generation' anti-psychotics and haloperidol is one of them. The newer ones are called second generation or 'atypical' anti-psychotics – risperidone is one of these.

What the Government says

NICE guidelines on the use of anti-psychotic drugs in dementia recommend that they should only be used in the first instance if a person is severely distressed, or there is an ‘immediate risk of harm’ to them or other people. Generally speaking, the guidelines recommend that anti-psychotics should only be prescribed for people with dementia when all 'alternative measures' have failed.

The pros and cons of anti- psychotic drugs

Pros

1. Drug trials have shown that for people with Alzheimer’s disease, anti-psychotic drugs can have a small but significant beneficial effect on aggressive behaviour when prescribed for a short period of time – around 6–12 weeks.

2. Anti-psychotics can have a calming effect and be an important part of treatment for someone with dementia who is extremely distressed and in danger of hurting themselves or the people around them, such as family or carers.

Cons

1. Anti-psychotic drugs were over-subscribed for many years. Even now they only help around 50 per cent of the people with dementia who take them.

2. Anti-psychotics can have serious side effects, particularly if they’re taken for longer than 12 weeks. For example, they can increase the risk of a stroke by up to nine times, and lead to excessive sleepiness and unsteadiness, which can, in turn, cause falls and injuries. In fact, a Department of Health review found that antipsychotic drugs contribute to around 1,800 deaths per year.

BUT
• The UK prescription rate for anti-psychotic drugs has fallen by 52 per cent since 2008.
• Better understanding of the reasons why people with dementia can become angry or aggressive, could account for this, and mean that the prescription rate will drop even further.

Anti-psychotics and nursing homes

Research shows that care home residents are more likely to be offered anti-psychotic drugs than people with dementia who live in the community.

Did you know? A 2013 study by Queen’s University Belfast found that around 20 per cent of elderly people in care homes are given anti-psychotic drugs, compared to one per cent of people the same age still living in the community.

But: This could be because people in nursing homes are often in the later stages of dementia when hallucinations and aggressive behaviour can be more pronounced. For example, if they are suffering from a frightening hallucination and in danger of hurting themselves – or someone else – an anti-psychotic could provide them with some much needed relief, and help them to calm down.

So if your loved one has been prescribed anti-psychotic drugs in a nursing home:

Do

• Check what other methods were used to help her calm down before the drug was given.
• Ask to see documentation of the events which led up to the drug being administered. Everything should have been written down.

Don't panic

• There may have been a good reason for the drug being given. The vast majority of nursing professionals don’t want to administer drugs unnecessarily to their patients, particularly ones which have a sedatory effect.