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Veterans nursing homes have made significant strides in reducing antipsychotic medication use, a new analysis shows. The decrease, however, may be contributing to the use of more alternative medications.

Providers should fully consider the parallel impact of reducing antipsychotic use before implementation, investigators say. 

A University of Michigan research team published findings Wednesday in the American Journal of Psychiatry about antipsychotic use among Veterans Health Administration patients. 

Antipsychotic prescribing dropped from 33.7% to 27.5% from fiscal 2009 to 2018. Anxiolytic prescribing also dropped from 33.5% to 27.1% during the same time period. 

The findings are in line with data released in March by the American Health Care Association. That group found the number of residents receiving antipsychotic medications declined from 2011 to 2020. 

Michigan researchers, however, also found that the prescribing of anti-epileptics, antidepressants and opioids increased significantly. Anti-epileptics prescriptions increased from 26.8% to 43.3% from 2009 to 2018, while prescriptions for antidepressants increased from 56.8% to 63.4% and opioids prescriptions increased from 32.6% to 41.2%. 

The overall prescribing of non-antipsychotic psychotropic medications grew from 75.0% to 81.1% from 2009 to 2018, data showed.

“While antipsychotic prescribing decreased in VA nursing homes, this was matched by parallel increases in anti-epileptic, antidepressant, and opioid prescribing,” said Lauren Gerlach, lead author and an assistant professor at Michigan Medicine.

“Policies singularly focused on driving down antipsychotic use in nursing homes, without considering other medications in context, may contribute to increased prescribing of alternative medications that are less likely to help patients and are potentially just as dangerous,” she added.