APA Releases List of Common Uses of Psychiatric Medications to Question

ARLINGTON, Va. (September 20, 2013) — The American Psychiatric Association today released a list of specific uses of antipsychotic medications that are common, but potentially unnecessary and sometimes harmful, as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. The list identifies five targeted, evidence-based recommendations that can prompt conversations between patients and physicians about what care is really necessary.

APA’s list includes the following five recommendations:

  • Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring
  • Don’t routinely prescribe two or more antipsychotic medications concurrently
  • Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia
  • Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults
  • Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders

“As clinicians, we know we can improve the care we deliver by engaging our patients in conversations about their care. The recommendations from APA released today provide valuable information to help patients and physicians start important conversations about treatment options and make informed choices about their healthcare,” said Jeffrey Lieberman, MD, APA President. “This is not to preclude the use of antipsychotic medications for these indications and populations, but to suggest that other treatment options should be considered first and patients should be engaged in discussion of the rationale for use and the potential benefits and risks.”

“Antipsychotic medications have tremendous benefits and improve the quality of life for many people with serious mental illness, however, they carry risks including potentially harmful side effects. Unnecessary use or overuse of antipsychotics can contribute to chronic health problems, such as metabolic, neuromuscular, or cardiovascular problems, in people with serious mental illness,” said Joel Yager, MD, Chair of the APA Council on Quality Care. “Because of these risks, APA has recommended that antipsychotics should not be used routinely, and should never be used without considerable thought, good clinical reasoning, and discussion with patients as to why under particular circumstances such a course would be preferable to alternative options.”

The American Psychiatric Association Choosing Wisely list was developed after months of careful consideration and review, using the most current evidence and consensus of expert opinion about management and treatment options. A work group of members from the Council on Quality Care developed a proposed list and solicited input from a broad group of APA members and leadership. The final list was unanimously approved by the APA Board of Trustees Executive Committee.

“The American Psychiatric Association has shown tremendous leadership by releasing its list of common uses of medication that aren’t always necessary,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “The content of this list and all of the others developed through the Choosing Wisely effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system and improve overall health.”

To date, more than 80 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the Choosing Wisely effort promoting conversations about appropriate care. Over the next year, more than 30 other specialty society partners will release Choosing Wisely lists. Some of the participating organizations include:

  • American College of Surgeons
  • American Academy of Orthopaedic Surgeons
  • Society of General Internal Medicine
  • American Academy of Family Physicians
  • American College of Emergency Physicians
  • American Association of Clinical Endocrinology/The Endocrine Society
  • American Society of Hematology
  • American Geriatrics Society
  • American Academy of Allergy, Asthma & Immunology

With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss. The campaign reaches consumers nationwide through consumer and advocacy partners, led by Consumer Reports.

To view the complete APA list and additional detail about the recommendations and evidence supporting them, visit www.psychiatry.org/choosingwisely. Also, see more on the Choosing Wisely national effort.