New York Times: Doctors Criticizing Antipsychotic Use In Elderly

I never thought I would read these words in the New York Times concerning anything to do with mental health.

"Ramona Lamascola thought she was losing her 88-year-old mother to dementia. Instead, she was losing her to overmedication."

OK, I'm being a bit rough there (the Times essentially made that point in its Zyprexa coverage after being over the top defenders of the psych faith for years), but now the paper of record has discovered the wild overmedication of the elderly in nursing homes, many months after the Wall Street Journal, St. Petersburg Times and CBC took it on, and well after I started hammering on the use of antipsychotics for dementia and their connection with sudden deaths and so on. But now that the Times has gone after it, they've done a good job.

"[M]any doctors say misuse of the drugs is widespread. 'These antipsychotics can be overused and abused,' said Dr. Johnny Matson, a professor of psychology at Louisiana State University. 'And there’s a lot of abuse going on in a lot of these places.'

"Dr. William D. Smucker, a member of the American Medical Directors Association, a group of health professionals who work in nursing homes, agreed. Though the group encourages doctors to conduct a thorough assessment and prescribe antipsychotics only as a last resort, he said, 'Many physicians are absent without leave in the nursing home and don’t take an active role in the assessment of the patient.'"

It goes from there with more doctors criticizing the use of antipsychotics--now a $13 billion market after being only a $4 billion market in 2000--and Janssen/J&J defending its marketing of Risperdal, an atypical antipsychotic that's the subject of lawsuit by the State of Arkansas over how the company allegedly marketed it for use in nursing homes.

"Ambre Morley, a spokeswoman for Janssen, the division of Johnson & Johnson that manufactures Risperdal, would not comment on the suits, but said: 'As with any medication, the prescribing of a medication is up to a physician. We only promote our products for F.D.A.-approved indications.'"

I wish the company luck with that line of legal argumentation in court. No quotes from Lilly in the story even though the company faces several similar lawsuits.

The paper even notes why so many studies show that dementia patients do better on placebo than on antipsychotics.

"Some doctors point out that simply paying attention to a nursing home patient can ease dementia symptoms. They note that in randomized trials of antipsychotic drugs for dementia, 30 to 60 percent of patients in the placebo groups improved.

'That’s mind boggling,' Dr. [UCSD psychiatrist] Jeste said. 'These severely demented patients are not responding to the power of suggestion. They’re responding to the attention they get when they participate in a clinical trial. They receive both T.L.C. and good general medical and humane care, which they did not receive until now. That’s a sad commentary on the way we treat dementia patients.'"

Yes it is. And the story has more, including how Lamascola got her mother back.

And, if it's not clear to anyone, let me point out that the way the antipsychotic market got so big so fast was mostly on the backs of people diagnosed with bipolar disorder and dementia--the market for schizophrenia had mostly been tapped for atypicals by 2000--and that's just wrong. It's time doctors took a hard look at how they are prescribing these pills to so many people. They aren't working out so well.