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Antipsychotics in dementia down and antidepressants up

The study

Researchers used data from the UK Clinical Practice Research Datalink (formally known as the General Practice Research Database) to look at primary care prescribing of antipsychotics, antidepressants, hypnotics, anxiolytics, acetylcholinesterase inhibitors and memantine to patients with dementia from 1995 to 2011. In 2009 the National Dementia Strategy identified a need to limit antipsychotic prescribing only to dementia patients who need as one of its 17 key objectives.

BMJ Open2013;3:e002080

The findings

Antipsychotic prescribing in patients with dementia by GPs dropped markedly- from 20% in 1995 to just over 7% in 2011. These figures are roughly equivalent to the National Dementia Strategy which reported last year that antipsychotic prescribing had dropped to just under 7% by 2011. But the new study also points to a significant increase in antidepressant use in these patients within the same time scale- up from 11% in 1995 to 26% in 2011. This conflicts with NDS data which suggests antidepressant use also dropped from just over 18% in 2006 to 13% 2011.Overall the new study also showed a small increase in anxiolytic prescribing and a drop in prescribing of hypnotics for dementia patients.

What does it mean for GPs?

The study leaders say the 2012 NDS audit was voluntary and included about half of GP practices while the CPRD uses data from around 650 of the UKs 10,000 practices- which could explain the disparity in the antidepressant data. But the overall picture- of GPs prescribing antipsychotics much less often to patients with dementia – is the same as the 2012 audit. They also say there appears to be a difference between patients who go on to start an acetylcholinesterase inhibitor than those who start memantine. Antipsychotics and antidepressants continue to be prescribed for some of those taking the former- although at a reduced rate. But antidepressant use stabilises – and antipsychotic use decreases – in those who take memantine.

Expert comment

Dr Kate Thomas, mental health GPSI in Glasgow, said: “It’s great that the huge effort GPs have made to rationalise antipsychotic use in those with Alzheimer’s disease has been confirmed in this study- but it suggests we were already doing this before the National Dementia Strategy told us to in 2009.

“The memantine result is intriguing and certainly echoes previous research and a Cochrane review which suggested it was more effective in managing behavioural and psychological symptoms related to dementia than the acetylcholinesterase inhibitors. But I think we’ll need much more solid data for that to make it into a guideline recommendation.”