Antipsychotics are being used for anxiety and dementia, despite licensed indications

A large proportion of people prescribed antipsychotics do not have a diagnosis of psychosis or bipolar disorder, research indicates.

The drugs are being used off-label for conditions such as anxiety, depression, dementia, sleep and personality disorders. This goes against National Institute for Health and Care Excellence guidelines that say use outside their main licensed indications is only recommended in unresponsive cases.

“These patterns of prescribing warrant some attention in terms of monitoring side effects particularly weight gain, extrapyramidal side effects and metabolic impacts,” write Louise Marston, from University College London, and her fellow researchers in BMJ Open

Her team analysed data from a UK primary care database called the Health Improvement Network to identify people who had received at least one prescription for an antipsychotic between 2007 and 2011. They found 13,941 individuals had received first-generation antipsychotics and 27,966 had been given second-generation agents.

Among those receiving a first-generation antipsychotic, the proportion of people with a diagnosis of psychosis or bipolar disorder ranged from 27% for haloperidol to 35% for chlorpromazine. With second-generation drugs, the proportion ranged from 36% for quetiapine to 62% for olanzapine.

Overall, antipsychotic prescribing rates were higher in women versus men, in those aged 80 years and over compared with those aged 40–49 years, and in people living in the most deprived areas versus the least deprived areas.

More than half of people receiving a first-generation antipsychotic had no severe mental illness (SMI) diagnosis but did have a code for a non-SMI mental health condition, such as anxiety, depression or sleep disorders. Between 12% and 17% of patients receiving first-generation antipsychotics had no record of an SMI or non-SMI mental health diagnosis. 



[1] Marston L, Nazareth I, Petersen I et al. Prescribing of antipsychotics in UK primary care: a cohort study. BMJ Open 2014;4:e006135. doi:10.1136/bmjopen-2014-006135.

Last updated
The Pharmaceutical Journal, PJ, 3/10 January 2015, Vol 294, No 7843/4;294(7843/4):DOI:10.1211/PJ.2014.20067475

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