Are Antidepressants and Antipsychotics being wrongly prescribed in Irish Nursing homes?

Antidepressants have been in the news again lately, this time relating to the dangerous side effects this medication can have on the elderly and the overprescribing of these drugs in nursing homes.

The inappropriate use of antipsychotic drugs is believed to lead to many residents’ deaths. David Graham, M.D., MPH, Associate Director, Science and Medicine, FDA Office of Surveillance and Epidemiology, testified in the House of Representatives in February 2007 that, by his estimate, “15,000 elderly people in nursing homes are dying each year from the off-label use of antipsychotic medications for an indication that FDA knows the drug doesn’t work.”  Link.

CNN reported that researchers found that 88% of the time, antipsychotic drugs were prescribed for elderly people with dementia.

This is precisely the population that faces an increased risk of death when using this class of drugs, according to the FDA. That’s why the agency puts its strongest safety warning, called a “black box warning” on these antipsychotic drugs, cautioning about the risk of death when taken by elderly people with dementia.

The report didn’t investigate why patients with dementia are prescribed antipsychotic drugs so often but alluded to a suggestion that many pharmaceutical companies have improperly promoted these drugs to doctors and nursing homes for many years.

Antidepressant risk factors, Anyone who takes antidepressants can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:

  • People over 65. Studies show that SSRI medications may increase the risk for falls, fractures, and bone loss in older adults. Link.

Reuters.

June 2011. A side effect of many commonly used drugs, including antihistamines and antidepressants, appears to increase the risk of reduced brain function and early death in older people. “Our results show a potentially serious effect on mortality,”  Link.

Disturbing articles in the Irish papers relating to this issue.

Mrs Maureen Stanley 79,  who was a resident in Bedford Nursing Home in Dublin’s Balbriggan, died on October 26th, 2003 after what had appeared to be a choking incident. At the Inquest her family raised a number of concerns including why Mrs Stanley was on anti-depressants. Toxicology tests showed a high level of medication in Mrs. Stanley’s system. Link.

In a 2009, the ombudsman Emily O’Rielly, said in her last annual report she highlighted how an elderly woman was heavily sedated, which affected her ability to communicate with her family over the last days of her life. She was given three times the dosage of anti-depressants she should have got because a mistake was made transcribing handwritten drugs records at Beaumont Hospital.

Again in 2009 at the inquest of an elderly woman who took lethal levels of a prescribed anti-depressant, the Dublin city Coroner said her death will be reported to the Irish Medicines Board. Dr Brian Farrell delivered an open verdict in the death of Ms Kitty Markey (85), Altadore Nursing Home, Glenageary, Co Dublin yesterday after he heard she died on May 15th, 2006 of toxic levels of the anti-depressant Surmontil. She had been prescribed the drug several years earlier and took it nightly.

Irish Times 2006, Drugs for elderly:  More than one in 10 residents of nursing homes and long-stay units for the elderly are receiving inappropriate medication to deal with the symptoms of dementia, new research has found. The study of 345 residents living in extended-care units in the west of Ireland found that of the 80 patients prescribed regular anti-psychotic medication, some 41 (51 per cent) were receiving the drugs inappropriately.

Residents living in private nursing homes were more likely to receive inappropriate anti-psychotic medication than those residing in public facilities. Anti-psychotic drugs, also known as major tranquillisers, are primarily used to treat schizophrenia, severe depression, bipolar disorder and other causes of psychotic behaviour. Using the drugs to treat restlessness, wandering and the intermittent aggression found in some patients with dementia is considered inappropriate.

Anti-psychotic medications are relatively ineffective in managing problem behaviours in dementia. And in terms of side effects, they are known to increase the risk of stroke in a patient group already at risk of cardiovascular problems.

Lundbeck targeting the Elderly?

A survey on the elderly and reported in the Irish Medical Times, done on behalf of Lundbeck (who else), states that the elderly are unlikely to discuss depression. Link.

Mind yourself, Depression in later life, Lundbeck again, have this to say…

Taking an antidepressant may help you to restore your mood to normal, allowing you to feel better about yourself. It is important to note that antidepressants are not addictive and will not turn you into a “zombie”. Side effects vary depending on which specific antidepressant you have been prescribed – in most cases these are mild and disappear soon after starting treatment. The majority of older people suffering from moderate to severe depression improve significantly with antidepressant medications. OOPS, They forgot about the reports of self harm and harm to others or the withdrawal symptoms but then again they’re not supposed to be addictive are they? Incidentally, Prof. Brian Lawlor who contributes to this leaflet is one of the 8 professors I have written about before.

 

 

Telegraph UK. 22/07/2011

Five dementia sufferers die each day after being wrongly prescribed “chemical cosh” drugs.

A Government-commissioned report published in 2009 estimated that 180,000 dementia sufferers are being prescribed anti-psychotic drugs but in as many as 150,000 cases they are unnecessarily being taken, often to keep patients quiet in hospital or nursing homes.

Because the “chemical cosh” drugs are feared to worsen other medical conditions and speed up mental decline, it is estimated that they lead to 1,800 needless deaths – five a day – every year. In addition, they are thought to cause 1,620 strokes, half of which are severe. Link.

 

America.

Although these drugs were not approved by the FDA for treatment of agitation and other symptoms of dementia/ Alzheimer’s, the government has found that they are commonly being prescribed to the elderly in nursing homes for these conditions.

A 2007 report listed “the treatment of agitation in dementia” as among the most common “off label” uses of antipsychotic drugs. This is despite the fact that the FDA has specifically warned that use of antipsychotics for treatment of dementia in the elderly may create “severe or life-threatening risks.” In April, 2005, the FDA issued a public health advisory that the risk of death almost doubled for elderly patients given antipsychotic drugs to treat agitation and other symptoms of dementia.

 

Update, 03/08/2011

Ssri antidepressants are more likely to cause death and issues such as heart attack, stroke, falls and seizures than older tricyclic antidepressants, according to a study published in the British Medical Journal (BMJ). Link.

One thought on “Are Antidepressants and Antipsychotics being wrongly prescribed in Irish Nursing homes?

  1. Another example of drug companies targeting the weak and vulnerable. Doctors who complicity prescribe these extremely dangerous drugs off-label to the elderly are also guilty of having no conscience. If you can’t abide by the Hippocratic oath then you shouldn’t be a doctor; I hear they’re hiring at McDonald’s.

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