Sep 27, 2013

The American Psychiatric Association (APA) has released a list of five uses of antipsychotic medications that are “common, but potentially unnecessary and sometimes harmful,” as part of a broader Choosing Wisely campaign by over 30 specialties in the medical profession.

The APA encourages people taking antipsychotic medications or their caregivers to discuss treatment options with their psychiatrists to confirm whether medications being prescribed are really necessary. The APA’s list of Five Things Physicians and Patients Should Question includes:

• Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.
• Don’t routinely prescribe two or more antipsychotic medications concurrently.
• Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
• Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.
• Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.

NAMI Medical Director, Ken Duckworth, M.D., warns that no one should change, adjust or discontinue a prescribed medication without consulting their doctor. At that same time, he goes further in outlining issues that should be discussed:

• Understand how medications integrate into psychosocial and self- management strategies that are also essential to treatment.
• Know what every medication is being taken for and understand the specific symptoms that are being targeted.
• Know common side effects like weight gain and movement disorders and how they need to be monitored and measured over time.

The APA recommendations are intended to “start important conversations about treatment options and make informed choices,” said Jeffrey Lieberman, M.D. APA President. "This is not to preclude the use of antipsychotic medications for these indications and populations, but to suggest that other treatment options should be considered first and patients should be engaged in discussion of the rationale for use and the potential benefits and risks."

“Antipsychotic medications have tremendous benefits and improve the quality of life for many people with serious mental illness; however, they carry risks including potentially harmful side effects. Unnecessary use or overuse of antipsychotics can contribute to chronic health problems, such as metabolic, neuromuscular, or cardiovascular problems, in people with serious mental illness,” said Joel Yager, M.D., Chair of the APA Council on Quality Care.

“Because of these risks, APA has recommended that antipsychotics should not be used routinely, and should never be used without considerable thought, good clinical reasoning, and discussion with patients as to why under particular circumstances such a course would be preferable to alternative options.”

The Choosing Wisely campaign is sponsored by the ABIM Foundation and is dedicated to “helping physicians and patients engage in conversations to reduce overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices.”