Antipsychotics and older people - new evidence on health risks

There has been much criticism in the past about the overuse of newer, atypical antipsychotic drugs to manage problem behaviour in elderly people with dementia. However, a new study by researchers from Brigham and Women's Hospital in Boston has suggested that alternative drugs may be just as dangerous. The researchers studied 10,900 people who were admitted to nursing homes in British Columbia between 1996 and 2006 and who received a psychotropic drug within 90 days of admission. The study found that people taking conventional antipsychotics, antidepressants and benzodiazepines were at higher risk of death and fractures of the femur. Levels of pneumonia and heart failure did not differ between those taking atypical antipsychotics and those taking other drugs.

Drugs and falling in older people

Researchers at the University of British Columbia have been looking into which drugs are linked to an increased number of falls in older people. They reviewed 22 studies on falls in people over 60 covering a total of 79,000 participants. They found that antidepressants had the strongest statistical link with falling but antipsychotics and benzodiazepines such as valium were also associated with an increased risk. Painkillers were found not to be linked to an increased risk of falling which is the fifth leading cause of death in the developed world.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/11/091123171410.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

XBD173 and anxiety

Benzodiazepines have dominated the anti-anxiety treatment market since the 1960s but can cause side effects such as drowsiness, forgetfulness and clumsiness and, over the long-term, dependency. Serotonin-specific reuptake inhibitors (SSRIs) have also been used to treat anxiety but can take weeks to take effect. German scientists have been experimenting with a new drug called XBD173. In a week-long study involving 70 participants they compared it to a placebo and a benzodiazepine. They found that it produced a fast, anti-anxiety response with no withdrawal symptoms after use.

You can find out more about this research at

http://uk.reuters.com/article/idUKTRE55H57N20090618?feedType=RSS&feedName=healthNews&sp=true

CBT and coming off benzodiazepines

Problems in coming off benzodiazepines can be related to rebound, where the initial problem (e.g. anxiety, sleep problems) is intensified, short-term withdrawal symptoms and re-ocurrence of the original problem for which the medication was originally prescribed. 80% of people who give up benzodiazepines subsequently relapse and even when people are weaned off the drugs gradually a significant number experience distress. For some time there has been a consensus that these problems can benefit from non-medical interventions and psychotherapy and a study of 86 people attempting to withdraw from Benzodiazepines in Montreal compared the effectiveness of cognitive behaviour therapy (CBT) and group therapy. Both were more effective than a control group although CBT did produce higher levels of self-efficacy (people's confidence that they could achieve their goals). Over all 86 participants a high initial level of psychological distress, anxiety and dosage predicted a poor outcome but increase in self-efficacy contributed towards a successful outcome. Although there was a decrease in positive mood during the course of the withdrawal there was no significant increase in negative mood.

O'Connor, Kieron ... [et al] - Cognitive-behavioral, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine Clinical Psychology and Psychotherapy, January-February 2008, 15(1), 1-14

Benzodiazepines and cognition

Despite advice to keep the duration of treatment short benzodiazepines are often prescribed for long periods of time, particularly in older people. Many people think benzodiazepines have a negative effect on people's cognition although the evidence from the research so far is inconclusive. A study of 2,105 people over 62 in Holland looked at people's benzodiazepine usage and tested their memory, intelligence and cognitive functioning over a 9-year period. At the end of the study the researchers found that benzodiazepines had a small, but statistically significant negative effect on people's long-term cognitive functioning.

Bierman, E. J.M. ... [et al] - The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent ? International Journal of Geriatric Psychiatry December 2007, 22(12), 1194-1200