What Physicians Say

Dr. Karl Steinberg
Mariner Health Care
"First of all, it should be made clear that antipsychotic medications are considered effective, and FDA approved, for the treatment of psychotic disorders, including schizophrenia, and for bipolar disorder.  Obviously, some of the patients in nursing homes have a history of psychosis and have been on these medications appropriately for many years, even though these precise diagnoses may not be known or listed in the chart.  What's more, a couple of the atypical antipsychotics are actually approved for treatment of major depressive disorder. 
 
It is clear that the scientific evidence does not support the use of antipsychotics for the diagnosis of dementia with agitation on a large-scale basis, but it is also clear that there are some cases in which these medications clearly do help. There is also no question that these medications are dangerous and do carry increased risk of bad outcomes. (Of course, so does insulin!) Yet despite their risks, I believe sometimes antipsychotic medications are not only medically necessary and appropriate, but also of great benefit.  This is particularly true in patients who are experiencing psychotic symptoms.  Dementia patients often become agitated because of psychotic symptoms like paranoid or other delusions (e.g., being held prisoner, being poisoned, an impostor is pretending to be my wife) or frightening hallucinations, where antipsychotics clearly help."

Cheryl Phillips M.D. CEO SNP Alliance

"To decry a single class of medications as "inappropriate" or link any use as "misuse" is to fail to understand the clinical science."

Cheryl Phillips, M.D.

CEO SNP Alliance
"Like all medications, those classified as psychoactive have the potential to provide significant help, relief of symptoms and suffering, as well as to have the potential for adverse outcomes. 

The important balance is thus for the treating physician and health professional to fully understand the underlying condition to be treated, to appreciate the risks and benefits of the medication, and to share that information with the patient and/or their care partners in an opportunity for fully informed decision-making.

There are times when the intervention with medication provides the safest and most optimum treatment for symptoms that would otherwise present significant personal suffering.  To decry a single class of medications as "inappropriate" or link any use as "misuse" is to fail to understand the clinical science. Equally, to assume that such meds alone can resolve complex challenges related to the care of persons with advanced dementia is to grab at a "quick fix" that creates additional burden and risk for those individuals treated.

The solution is an appropriate patient-centered partnership with the direct care and nursing staff, the family and patient, and the physician and treating health professionals.  Increasingly families and caregivers are struggling with how to best provide care for persons with advanced dementia who may have related aggressive behaviors, disturbing delusions and/or mood disorders that cause pain and suffering. Sadly, we know there are no simple solutions. But to try to eliminate one of the options that may provide some relief would only add to that challenge.”