Can antipsychotics make you permanently tired?

Better quality of life, better prognosis

Melperon and Pipamperon are approved for the treatment of sleep disorders in geriatric patients. These substances are favorable due to the lack of anticholinergic effects. In the case of substances with an anticholinergic effect, for example promethazine, levomepromazine, prothipendyl and olanzapine, delirium, i.e. an acute state of confusion, can occur, especially in older people. The duration of therapy is not limited by the manufacturer. A withdrawal attempt should be made after a maximum of three months (20).

In addition to being used as sleeping pills, antipsychotics are also used in patients with Alzheimer's disease. Risperidone is approved, but only for a treatment period of up to six weeks. In particular, the drug is intended to reduce aggressiveness, for example scratching or biting during personal hygiene or the refusal to eat and drink, which can occur towards nursing staff or relatives and which can make patient care extremely difficult. Risperidone should only be used if non-pharmacological measures do not respond and there is a risk of harm to yourself and others.

The risk of mortality and cardiovascular events (myocardial infarction, stroke, deep vein thrombosis) are significantly increased in elderly patients with dementia when taking antipsychotics. On the one hand, there are more arrhythmias and, on the other hand, more frequent pneumonia, which can lead to death (17). The exact mechanism by which antipsychotics increase thrombophilia or lead to pneumonia is still unknown.

When searching for the cause, authors of a study found that the mortality risk was only increased in patients with relevant drug interactions, especially when combined with drugs that lead to additive blood pressure lowering, QTc prolongation, sedation or additive hematotoxicity. The risk increases with the number of interactions: the risk HR (hazard ratio) for one interaction is 1.49, with two interactions 1.65 and with three interactions 1.79 (18). The doctor and pharmacist should therefore look for interactions and adjust the medication if necessary. In addition, attention should also be paid to drug-disease interactions in order to minimize the risk, for example cardiovascular, haematological or metabolic diseases that could be worsened by the antipsychotics.

The BfArM has commissioned an investigation to examine the risk of the individual antipsychotics in older patients. Compared to risperidone, the very frequently used antipsychotics pipamperon and melperon, but also levomepromazine, zuclopenthixol and haloperidol had a significantly increased mortality risk. Quetiapine, olanzapine, amisulpride, clozapine, and flupenthixol were found to have a lower risk than risperidone (19).

People with dementia should take risperidone for this indication for no longer than six weeks (according to the manufacturer) or, according to current data, no longer than three months (20). A withdrawal attempt is indicated at regular intervals in order to keep the duration of therapy as short as possible. A dose reduction also lowers the mortality risk (21).