People with dementia can become distressed, which can lead to symptoms such as increased aggression, anxiety, agitation, depression and delusions. However, these behaviours may have other causes, including pain or delirium. Understanding the causes of these behaviours and addressing them can avoid the use of unnecessary interventions, such as antipsychotic medication.

Our guideline on dementia recommends that before starting treatment with antipsychotic medicines the benefits and harms should be discussed with the person and their family members or carers. They should only be offered to people living with dementia if they are:

  • at risk of harming themselves or others
  • experiencing agitation, hallucinations or delusions that are causing them severe distress.

study by Donegan et al of trends in treatment for people with dementia in the UK found that over 10 years the NHS has halved the prescribing of antipsychotic medicines in general practice to people with dementia, from 22% in 2005 to 11% in 2015.

More recent data from NHS Digital shows, in October 2019, the proportion of patients with a recorded diagnosis of dementia who had a prescription of antipsychotic medication in the previous 6 weeks was stable at just over 9%. Variation in the levels of prescribing antipsychotic medication could be seen across CCGs, ranging from 4% to 17%. In CCGs where antipsychotic prescribing is above or below the national rate, further investigation may be necessary to understand the factors contributing to these rates.

The Prescribing Observatory for Mental Health 10-year report highlights good practice in antipsychotic prescribing which may help to reduce variation. This includes alternatives to antipsychotic medication, such as music, exercise or aromatherapy and clear documentation of aggressive or agitated behaviour. These areas were all highlighted in our patient decision aid. In addition, improvements could be made in the frequency and quality of reviewing antipsychotic medication for people with dementia.

Our patient decision aid on antipsychotic medicines for treating agitation, aggression and distress in people living with dementia provides information to help people living with dementia, their family members and carers and their healthcare professionals discuss the options.

Variation in prescribing of antipsychotic medication to people with a diagnosis of dementia across CCGs in England, October 2019