Appropriate Use of Psychotropic Medications

Psychotropic medications are drugs that affect the brain’s activities associated with mental processes and behaviors. These medications may also be referred to as psychoactive drugs and are generally prescribed to treat mental illnesses, including anxiety, depression, psychosis and schizophrenia. 

The types of psychoactive drugs include:

  • Anticonvulsants: Also called antiepileptics, these medications are often used to reduce the frequency and severity of seizures. They are also used in the treatment of mental illnesses, including bipolar disorder or borderline personality disorder. 
  • Antidepressants: These medications are prescribed to treat depression, usually by increasing the availability of certain chemical messengers (neurotransmitters) in the brain.
  • Antipsychotics: Medications used to manage psychosis, primarily in people with schizophrenia. Antipsychotics are also used to treat other psychotic disorders and as an adjunct in the treatment of bipolar disorder. 
  • Anxiolytics: Also called anti-anxiety drugs, these medications are used to treat anxiety, mild behavioral agitation and insomnia. They may also be used as adjunctive treatment for depression and panic disorder. 
  • Sedatives and hypnotics: These medications are used to induce or sustain sleep by increasing drowsiness and decreasing motor activity. The difference between a sedative and a hypnotic is generally the dose prescribed, with higher doses of a medication used to achieve hypnotic effects and lower doses for sedation or to relieve anxiety.  

In nursing facilities (NFs), there has been a tremendous focus on antipsychotic medications – often prescribed inappropriately to treat the behavioral and psychological symptoms of behavioral and psychological symptoms of dementia (BPSD). Since 2014, there have been significant efforts to reduce the inappropriate use of antipsychotics. However, recent data suggest that as antipsychotic use has decreased in NFs, the use of other psychotropic medications has increased. The U.S. Department of Health and Human Services Office of the Inspector General’s report “Long-Term Trends of Psychotropic Drug Use in Nursing Homes (PDF)" suggests that up to 80% of Medicare beneficiaries living in a NF had been prescribed a psychotropic medication. 

While psychotropic medications are important tools for treating mental illness, they are not without risk, even when prescribed appropriately. When prescribed inappropriately, the risks will generally outweigh the benefits of these medications. When prescribed appropriately, psychotropic medications can have a positive impact on a person’s quality of life and the quality of care they receive in a NF. 

For example, all antipsychotics carry a black box warning required by the U.S. Food and Drug Administration (FDA) stating that they are associated with increased rates of stroke and death in older adults with dementia. In 2023, the FDA approved the use of the antipsychotic brexpiprazole to treat agitation related to Alzheimer’s disease. Despite this new indication for use, brexpiprazole still carries the black box warning. The physician must consider the risks versus benefits before prescribing this medication, and non-pharmacological interventions should be the first line of treatment in these situations. 

NFs must develop well-defined processes for monitoring the use of psychotropic medications, promoting gradual dose reductions when indicated and preventing the inappropriate prescribing of these drugs. Each person receiving a psychotropic medication should have ongoing monitoring for targeted behaviors and potential adverse reactions. Some medications may require specific monitoring processes, including laboratory or other diagnostic testing. 

Non-pharmacological interventions should be considered as part of any behavioral management program. This may require changes in facility policies, procedures and nursing care practices. All staff should be trained on behavior management techniques. 

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