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Antipsychotic drugs can serve a vital purpose in nursing homes

Dementia is a major health concern of our aging population. The safe, effective treatment of dementia’s behavioral complications challenges those who care for the cognitively impaired. The front-page articles “A rampant prescription, a hidden peril” (April 29) and “Finding alternatives to potent sedatives” (April 30) informed the public of the hazards of using antipsychotic drugs in nursing homes without providing the balance necessary for understanding this issue.

As geriatric psychiatrists, we support the view that behavioral interventions are foremost in treating dementia’s behavioral symptoms. Nursing home staffing should be enhanced and staff trained in these techniques. Yet some residents will fail to respond. Their agitation and aggression create suffering and danger. Antipsychotics effectively treat conditions that affect some of these people, such as schizophrenia, bipolar disorder, and depression.

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These and other medications may be appropriate in some patients with dementia, at the lowest effective doses, for the shortest duration needed, with appropriate informed consent. Their modest benefits and significant side effects must be carefully monitored. No medications have been shown more effective for this purpose, and “off-label” use is a medically accepted treatment approach.

Someday we’ll have better medications to combine with behavioral treatments. Meanwhile, demonization of anti-psychotics may limit treatment options and discourage nursing homes from accepting behaviorally difficult patients. These institutions deserve our support, not condemnation.

Dr. David Harnett

Dr. James Ellison

Massachusetts

Psychiatric Society

Wellesley

The writers are members of the organization’s geriatric psychiatry committee.

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