Scientists Expose Hidden Dangers of Antipsychotic Medications

Researchers at the University of Waterloo analyzed data from nearly 500,000 Canadian nursing home residents from 2000 to 2022. The study found that residents prescribed antipsychotic medications experienced a significant decline in behavior. Notably, follow-up assessments revealed that 68% of those using antipsychotics demonstrated increased behavioral problems, the Journal of the American Medical Directors Association reported.

“This is the first national longitudinal study of its kind, using a statistical technique to measure the effect of antipsychotic treatments,” said Dr. Daniel Leme, the study’s lead author and a postdoctoral scholar in Waterloo’s School of Public Health Sciences.

Antipsychotic medications are frequently prescribed in nursing homes for “off-label” uses, meaning they are administered for conditions not officially approved by health authorities such as the U.S. Food and Drug Administration (FDA). For instance, these drugs are sometimes used to manage behaviors linked to dementia, even though they are only FDA-approved for treating disorders like schizophrenia or certain forms of psychosis. A study revealed that between 2014 and 2020, 26% of nursing home residents in Canada were prescribed antipsychotics in ways not recommended by the FDA.

While antipsychotics are often employed to calm residents displaying aggressive or agitated behavior, their use comes with significant risks. Potential side effects include tremors, restlessness, muscle rigidity, painful contractions, and difficulty standing or walking. These adverse effects can worsen existing behavioral and psychological symptoms.

“Sometimes people may say they don’t have enough staff to deal with these issues, but the reality is that these medications can make disability and cognitive impairment worse,” said Dr. John Hirdes, a professor in the School of Public Health Sciences. “We need to seriously reconsider the use of antipsychotics for people who do not have conditions associated with psychosis.”

The study outlines the inappropriate use of antipsychotics to treat behavioral and psychological symptoms of dementia (BPSD), which can include irritability, aggression, agitation, anxiety, depression, sleep or appetite changes, apathy, wandering, repetitive questioning, sexually inappropriate behaviors, and refusal of care.

Instead of turning to medication right away, researchers suggest focusing on person-centered care — getting to the root causes of a resident’s behavior and offering support in other ways. For example, a resident might need better pain management, clearer communication, or activities to help reduce anxiety. Non-drug therapies like music, art, social interaction, and gentle exercise have been shown to help manage behavior without the need for antipsychotics.

Training staff to understand the risks of antipsychotics and how to offer better care has also been linked to improved outcomes for nursing home residents, including less agitation and a better quality of life.

4155/v