Antipsychotics such as haloperidol and risperidone are associated with a significant and dose-related increase in mortality in elderly patients with dementia, compared with antidepressants or nonuse, a retrospective case-control study involving 90,786 patients has found.

Patients taking haloperidol had a 3.8% increase in mortality, and those taking risperidone had a 3.7% increase relative to nonusers, while olanzapine and quetiapine also were associated with significant increases in mortality risk, according to a study published online March 18 in JAMA Psychiatry.

When compared with individuals on antidepressants, haloperidol was associated with a 12.3% increase in mortality, representing a number-needed-to-harm of 8, while antidepressants alone were associated with a small but statistically significant increase in mortality risk.

“Prescribing a medication that increases mortality risk seems contrary to the tenet ‘first, do no harm,’ yet for patients who pose a danger to themselves and others and are in profound distress, use of such medications may still be appropriate,” wrote Dr. Donovan T. Maust of the department of psychiatry at the University of Michigan, Ann Arbor, and his coauthors (JAMA Psychiatry 2015 March 18 [doi:10.1001/jamapsychiatry.2014.3018]). “These new data can help physicians minimize the potential harm associated with antipsychotic treatment.”

The study was supported by the National Institute of Mental Health, the National Institute on Aging, the American Federation for Aging Research, the John A. Hartford Foundation, and the Atlantic Philanthropies. One author reported grants, research support, and consultancies with several pharmaceutical companies, and others reported receiving grants from the study’s supporters.


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