Antipsychotic Medication Isn't Always the Answer

American Psychiatric Association explains when antipsychotic medication should not be used

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Psychiatric medication may be unnecessarily prescribed. How do you know when a treatment option is right for you?

The American Psychiatric Association (APA) recently released a set of five guidelines on the safe and correct use of antipsychotic medication. The list serves to inform both patients and doctors of the potential risks of unnecessary use or overuse of these medications.

The APA explained that these suggestions are not meant to stop or prevent the use of antipsychotics, but to include the patients in their own treatment and let them make educated decisions alongside their doctors. Sometimes the use of these medications is very beneficial, but they run the risk of being overprescribed.

The misuse of these medications can have potentially harmful side effects.  The APA wants patients to be aware of other possible treatments and able to consider the most beneficial options.

"Discuss treatment options in detail with your psychiatrist."

The APA assembled a work group of members from the Council on Quality Care to create the initial list. The work group then got input from a large group of APA members and leadership.

The APA Board of Trustees executive committee approved the final five items:

1. "Don't prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring."

Joel Yager, MD, Chair of the APA Council on Quality Care, explained that these medications could seriously affect patients' neuromuscular system (nerves that control voluntary muscle movements), cardiovascular system (heart and blood vessels) and metabolic system (processes that turn food to energy).

Therefore, the APA recommends that doctors should conduct a very thorough evaluation before beginning treatment — considering any possible underlying causes for the symptoms in question, any other medical conditions the patient may have or be at risk for and the patients' family medical history.

And throughout treatment, patients should be closely monitored. That is, doctors should continuously assess if the dosage of the medication is appropriate, ask the patients if they are experiencing any side effects and keep a record of the patients' weight, blood pressure, blood sugar, nervous system and movement abilities.

2. "Don't routinely prescribe two or more antipsychotic medications concurrently."

Previous research has shown that 4 to 35 percent of outpatients, and 30 to 50 percent of inpatients, use two or more antipsychotic medications. The APA explains that, to date, there is limited evidence surrounding the effectiveness and safety of combining these medications. There is a high risk of negative side effects resulting from interactions between multiple medications, side effects if the patient stops taking the medication correctly and very unhealthy consequences if the patient or doctor makes a mistake with the medication dosage.

The APA maintains that the use of two or more antipsychotics should be avoided unless one-medication treatment has failed three times.

3. "Don't use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia."

Previous research has shown that there are multiple, serious risks that outweigh the potential benefits of using antipsychotic medications for the treatment of behavioral and psychological symptoms of dementia (e.g., agitation, aggression, anxiety, irritability, depression, apathy and psychosis). The APA believes that doctors should limit the use of these medications to cases of dementia for which non-medicinal treatment attempts have failed and when the patients' symptoms present a danger to both the patient and others.

4. "Don't routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults."

The APA explains that there is limited and mixed evidence on the effectiveness of using antipsychotic medication for the treatment of insomnia.

5. "Don't routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders."

Recent research has found that the use of antipsychotic medication for treating children has almost tripled in the past 10 to 15 years. The increase has mostly happened among children in low income households, minority children and children with externalized behavioral disorders such as ADHD (attention deficit hyperactivity disorder) or other conduct problems.

The APA explains that the evidence on the effectiveness and tolerability of antipsychotic medications for children and adolescents is lacking, and there is a much larger concern about weight gain, metabolic side effects and cardiovascular issues in children compared to adults.

All of these recommendations are evidence-based and have been carefully chosen by the APA.

This list was released online September 20 by the American Psychiatric Association, as part of Choosing Wisely: An Initiative of the American Board of Internal Medicine Foundation.

Review Date: 
September 24, 2013
Last Updated:
September 26, 2013