The percentage of older adults treated with antipsychotic drugs increases with age, a National Institute of Mental Health-funded study finds. While the number of affected people is very small, the concern is great due to the fact that antipsychotics may pose significant health risks to seniors. Specifically, antipsychotic drugs increase the risk of strokes, fractures, kidney injury, and mortality in older adults, while potentially causing the lesser side effects of weight gain and metabolic problems.

“With advancing age, adults treated with antipsychotic medications were more likely to receive their prescriptions from nonpsychiatrist physicians than psychiatrists,” wrote the authors of the new study. Beware the family doctor bearing psychiatric drug prescriptions?

Antipsychotics, among the most common medications in the United States, are also frequently prescribed off-label — for a use not approved by the Food and Drug Administration. In office-based practices, the researchers explained, just 45 percent of adults under the age of 64 and only a quarter of adults 65 or older with an antipsychotic prescription are actually patients diagnosed with one of the FDA-approved illnesses: schizophrenia, bipolar disorder, Tourette’s disorder, and major depression (as a secondary treatment only).

In other words, considerably more than half of all adults taking an antipsychotic have been prescribed the drug off-label.

Researchers from Columbia University, New York State Psychiatric Institute, and Yale University teamed up to learn exactly how often these drugs are prescribed to adults and how they are being used. To investigate, the team analyzed de-identified prescription data from nearly 33,000 retail pharmacies. They looked for prescriptions of haloperidol, pimozide, aripiprazole, and olanzapine. In sum, the gathered data captured 63 percent of all retail prescriptions in the U.S., a nationally representative sample with respect to age, sex, and health insurance.

What did they discover? The percentage of people receiving an antipsychotic prescription in 2010 was approximately twice as high among people between the ages 80 and 84 as among those between 65 and 69, the researchers found. Basically, prescriptions increased with age after age 65.

Strikingly, about 80 percent of all antipsychotic prescriptions for adults 65 and older were off-label. And, nearly half of the older adults who had used antipsychotics between 2006 and 2010 had taken the drugs more than 120 days in the year, the researchers found. Across the adult lifespan, women had higher rates of antipsychotic use than men, which the authors of the study attribute to higher rates of depression and possibly higher rates of depression.

Source: Olfson M, King M, Schoenbaum M. Antipsychotic Treatment of Adults in the United States. Journal of Clinical Psychology. 2015.