As hard as I fought for warnings on antidepressants - and I still think they are important - I have come to the sad conclusion that they made little difference in prescribing habits with the possible exception of a few short months at the end of 2004, going into 2005. And maybe Paxil became somewhat less popular - relative to other antidepressants - with physicians (probably more from their own observations than the publicity that surrounded the warnings that specified Paxil a lot). It's going to take a lot more than a few words surrounded by heavy black lines to stop the momentum towards using these drugs for every little concern out there. They are just too convenient in terms of shutting people up and giving them little hits of sedation or stimulation. Let's just hope that people are becoming a little wiser about some of the adverse effects when they arise.

I am kicking myself in the ass for responding here, but I want to make sure readers know another perspective to this issue with use of antipsychotics in the elderly.

Go to nursing homes, to homes where family members are housing an infirmed, demented parent or grandparent, or to day programs that work with senior citizens, and listen to the sheer number of people who not ask, but clamor or demand meds to intervene with the disruptive behaviors that inevitably occur with dementia, chronic medical illnesses, and just boredom or resentment by these people who have been basically abandoned by family and the community. Again, it's this quick fix mentality that gets shoved in our faces as psychiatrists to quiet, control, manage people who are almost always victims of illnesses or cultural abandonment that is beyond drugs. Unfortunately, too many psychiatrists are too happy to oblige and write for antipsychotics because they'll do the job: sedate, impair, and chemically redirect. That's one reason why I do not do much geriatric work these days; people do not want to hear there are behavioral and interpersonal interventions that are equally if not intially needed before meds are introduced. So, again, rail at the psychiatrist for providing the service screamed for, or , perhaps, rail at the society that asked for it in the first place.

you know what is going to be on my gravestone: No good deed went unpunished. That is my epitaph since I started medical school. Become a doctor, then rail away at me because you do know better because you've done better!

I am aware of the circumstances in nursing homes. I have a colleague who knew that an antipsychotic given to her mother would probably kill her but felt the situation was so dire that the drug was warranted. But I have to take exception at a psychiatrist (above) feeling sorry for himself for knowingly causing death, no matter what the circumstances. I know a psychiatrist who knowingly caused the death of my child, and I know what I would like to put on his gravestone.