APA releases guidelines on antipsychotic drug use

Antipsychotic medications should not be used as first-line treatment for residents with dementia, according to a new set of guidelines from the American Psychiatric Association (APA).

The report offers five key guidances designed to reduce the excessive or unnecessary use of antipsychotic medications:

  • Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.   
  • Don’t routinely prescribe two or more antipsychotic medications concurrently.  
  • Don’t prescribe antipsychotic medications as a first-line intervention to treat behavioral and psychological symptoms of dementia.    
  • Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.   
  • Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.      

The rise of so-called second-generation or “atypical antipsychotic” drugs—including Abilify, Risperdal, Zyprexa and at least 15 others—has contributed to a growing use of drugs to treat an expanding field of behaviors. However, even second-generation antipsychotics carry risks of side-effects, including stroke, diabetes, weight gain and body tremors that could masquerade as Parkinson’s symptoms, psychiatrists note.

“Antipsychotic medications have tremendous benefits and improve the quality of life for many people with serious mental illness, however, they carry risks including potentially harmful side effects. Unnecessary use or overuse of antipsychotics can contribute to chronic health problems, such as metabolic, neuromuscular, or cardiovascular problems, in people with serious mental illness,” said Joel Yager, MD, Chair of the APA Council on Quality Care, in an APA announcement. “Because of these risks, APA has recommended that antipsychotics should not be used routinely, and should never be used without considerable thought, good clinical reasoning, and discussion with patients as to why under particular circumstances such a course would be preferable to alternative options.”

The APA guidelines are part of the Choosing Wisely campaign, an initiative launched by the American Board of Internal Medicine Foundation and supported by more than 50 medical specialty organizations.


Topics: Alzheimer's/Dementia , Clinical