During my last conference in Denmark, I learned of an interesting trend in antipsychotic use. After I quoted a 2003 Danish Medicines Agency report earlier in the week that showed a 28% prevalence of antipsychotic use in care homes, I was told that Denmark had been making a concerted effort to reduce antipsychotic use since then. And they have. But that’s not the whole story…
I heard a talk by Dr. Annette Lolk, who reviewed the use of psychotropic drugs in Denmark. Though the talk was in Danish, she knew I was coming, and was kind enough to translate most of her slides on a handout, so I could follow along. Using bar graphs that separated older Danes in 5-year cohorts, Dr. Lolk showed that overall antipsychotic use had dropped from 2005-2009 in every cohort except the 65-69 year-old group. The decreases ranged from about 16 – 22% in the various groups.
But despite an overall reduction in this class of drugs, there was a significant increase in the use of one particular drug: quetiapine (branded as Seroquel). The increase in quetiapine use during this period ranged from a 54% increase in 80-84 year-olds, to a 105% increase in those over 95 (!), and a whopping 149% increase in the 65-69 group (which probabaly explains why overall use did not decline in this youngest cohort).
To me, this phenomenon is probabaly best explained as a better marketing campaign. Seroquel has gotten a rep as a brand less likely to cause Parkinson-like stiffness as a side effect, so that the comfort level of its use has been raised. Some also claim it to be less sedating than other brands, although low doses are claimed to be paradoxically more sedating than higher ones, which also encourages higher initial doses.
But side effect profiles aside, this begs a larger question: If one believes, as I do, that the majority of distress in dementia comes from unmet needs and environmental mismatch eroding one’s well-being, then no drug solves the real problem, regardless of its safety profile. The fact that Seroquel use is rising even as we strive to reduce antipsychotic use shows that we still have a long way to go in shifting paradigms for enlightened care.