Dr. Lon Schneider, professor of psychiatry, neurology and gerontology at the University of Southern California Keck School of Medicine, was intrigued by the study's findings.
"This was a pragmatic study with good design and the main findings are enlightening about the extensive level of adverse events and the very limited efficacy of these drugs," said Schneider, who wrote a commentary on prescribing antipsychotic medicine in the August issue of the journal Clinical Neurology News.
Schneider said the new study confirms what has been seen in effectiveness trials and in observational studies.
"The important information that it adds is the considerable level of adverse events," he said. "The study shows that when drugs are compared head to head, there is a high level of discontinuation due to intolerability. You don't see this in the pharmaceutical company placebo control trials."
Another expert said the new findings are not surprising.
"There have been concerns about the efficacy of these antipsychotic drugs for a long time," said Dr. Dan Blazer, chairman and professor of psychiatry at the Duke University School of Medicine. He added that this research will "put more pressure on the brakes."
"[But] there are individual patients in whom these types of drugs can make a big difference," Blazer said. "The issue is caution in using them."
Blazer and Schneider both warned that the danger is in using them as a "chemical straitjacket," which can happen in nursing homes and private homes when caregivers aren't always available.
There are no magic bullets to treat agitation and aggressive and threatening behavior, but there are alternatives to prescribing drugs, such as cognitive behavioral therapy, Schneider said.
Jeste concluded: "The practical implication of our research is that we should be very careful in using any of these drugs in people over 40, especially if we are using them off label for any length of time."
The U.S. National Institute of Mental Health has more about mental health medications.
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