Treating Alzheimer's with Antipsychotic Drugs
Antipsychotic drugs, which have been traditionally administered to mentally ill patients with psychosis (such as schizophrenia), are now being prescribed for some people with Alzheimer's disease (AD). Concerns about potentially dangerous side effects have surfaced.

What are Antipsychotic Drugs?

Antipsychotic drugs are used to treat mental illnesses such as psychoses (schizophrenia and bipolar disorder, for example), in which patients lose touch with reality and exhibit symptoms that include hallucinations, delusions and paranoia. Antipsychotic drugs can reduce some of the symptoms and allow people with debilitating mental illnesses to lead more normal lives.

Typical Antipsychotic Drugs

There are two "generations" of antipsychotic drugs. The first generation is called "typical" (or "conventional") antipsychotic drugs. They have been available since the 1950s and include chlorpromazine, haloperidol, perphenazine and fluphenazine.

According to the National Institute of Mental Health (NIMH), typical antipsychotic medications can cause serious movement-related side effects such as rigidity, persistent muscle spasms, tremors and restlessness. And their long-term use may result in tardive dyskinesia (TD), a condition that causes uncontrollable muscle movements, typically around the mouth. Only some people with TD fully recover after they stop taking the medication. Others may have a partial recovery.

The side effects that cause these movement problems are called "extrapryramidal."

Atypical Antipsychotic Drugs

Second generation, or "atypical" antipsychotic drugs were developed in the 1990s. According to, atypical antipsychotics are less likely to cause extrapyramidal side effects than typical antipsychotics. TD is much rarer in people who take atypical antipsychotics as opposed to typical antipsychotics, but to be safe, patients on atypical antipsychotics should know and watch out for the symptoms.

Atypical psychotics include risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone and clozapine. Of these drugs, only clozapine, according to the NIMH, can cause agranulocytosis, a loss of the white blood cells that help a person fight infection. People who take clozapine must get their white blood cell counts checked every week or two.

Antipsychotics and Alzheimer's Disease

Antipsychotics have been found to be effective drugs for people with dementia and AD who exhibit problems such as delusions, aggression, agitation, hallucinations and similar symptoms. But while the antipsychotics typically prescribed for AD patients have been approved by the U.S. Food and Drug Administration (FDA) to treat psychosis, schizophrenia, depression and other mental illnesses, they have not been approved by the FDA to treat AD, according to the Alzheimer's Association (AA).

An NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness—Alzheimer's Disease (CATIE-AD) study of atypical and typical antipsychotics used for AD found that AD patients who took the typical antipsychotics had a higher risk of death than those taking the atypical drugs, according to NIMH. However, for both types of drug the increased risk of dying was slight.

The findings were published in The New England Journal of Medicine in 2006. The atypical antipsychotics they studied were Abilify, Clozaril, Zyperax, Seroquel, Risperdal and Geodon and the typical antipsychotics were Tindal, Thorazine, Prolixin, Permitil, Serentil, Trilafon, Malleril, Stelazine, Vesprin, Taractan, Haldol, Loxitane, Moban, Orap and Navane.

According to the NIMH, CATIE-AD also found that atypical antipsychotic medications were associated with weight gain and other metabolic changes among patients with AD. This may increase the patient's risk of getting diabetes and high cholesterol, and the patient's weight, glucose levels and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic.

The study concluded that antipsychotics appear to be no more effective than a placebo when adverse side effects are considered, and that the newer generation of antipsychotic drugs is no safer than the older generation.

Proceed with Caution

According to NIMH, of the 421 CATIE-AD participants, 26 to 32 percent of those who took the active medications improved, compared to 21 percent of those who took the placebo. But the antipsychotic medications were more frequently associated with side effects such as sedation, confusion and weight gain than the placebo.

The AA advises that you or your loved one with AD should not stop taking antipsychotic drugs if the doctor prescribed them. Rather, discuss with the doctor the drug's potential benefits versus the potential risks, and keep in mind that Alzheimer's patients who have psychotic-like symptoms also take a risk by not treating their symptoms with the drug. If you are taking antipsychotic or other drugs, tell your doctor if you experience new or unusual symptoms.

For more information visit the Alzheimer's Association, National Institute of Mental Health and CATIE.