Antipsychotic medications are widely used in dementia to
control behavioral symptoms. Many studies noted a relationship between
increased risk of death among dementia patients and the use of antipsychotics.
However, most patients experience difficult to manage behavioral symptoms in
dementia and the death may be due to the disease process itself.
Study published in American journal of psychiatry looked
into the mortality among dementia patients who are treated with various anti-psychotic
medications. This study compared differences between deaths
rates in different anti psychotics using historical data.
According to this study Haloperidol (Haldol) is associated
with most number of deaths. Quetiapine (Seroquel) is associated with lowest
death rates. Other antipsychotics such as Risperdal, and Zyprexa, lay in-between.
Analysis of this study
However, there is a caveat in this study. It is that this
study used archived data. In these data most people with severe dementia were
given haloperidol, because some clinicians believed that Haldol is more
effective in controlling behavioral symptoms than other antipsychotics. Therefore,
naturally they used Haldol frequently in patients with more severe dementia. These
patients have high death rates even without any antipsychotics. Therefore, this
study may be biased toward newer anti psychotics.
In addition, we need to understand that there are very
strong pharmaceutical companies to promote newer antipsychotics.
Nobody promotes older antipsychotics such as Haldol even though they are preferable
in certain patients.
Journal article in American journal of Psychiatry
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