– Since many elderly people are more susceptible to side effects when using this medicine, we were surprised that the increase was so large. That’s what Marit Tveito says to news. She is section chief at the Center for Psychopharmacology at Diakonhjemmet, a hospital specialist in psychiatry and has researched the use of antipsychotics among the elderly. From 2006–2018, she and others found that the use of antipsychotic drugs generally decreased. But there was one drug that stood out – in terms of increasing use: The drug is called Seroquel (Quetiapine) and is only approved for use among the elderly and demented with psychotic disorders in Norway. – In our study, we could not investigate what it was prescribed for, but there are several studies that show that this medicine is often used outside the approved indication, for example for sleep disorders, says Tveito. Warnings when using antipsychotics Antipsychotics are drugs that are supposed to work against symptoms of serious mental illness. Such as schizophrenia. They can bring with them a number of side effects. The Joint Catalog states the following: If you are an elderly person with dementia, you should not take Seroquel. This is because the group of medicines to which Seroquel belongs can increase the risk of stroke. In some cases, the risk of death increases in older people with dementia. There are also limitations when using it for the elderly without a dementia disease: The drug is recommended and given with caution to the elderly, especially initially. Slower dose titration and lower maintenance dose may be required. The plasma clearance (decomposition time) for quetiapine is on average 30-50% lower in the elderly. Multifold increase in ten years Figures from the Prescription Register also show the same tendency. The figures do not include the use of Seroquel in Norwegian nursing homes. According to the statistics, 2,697 elderly people over the age of 60 used Seroquel in 2010. In 2021, the number of users had increased to 20,571. There is talk of a sixfold increase in eleven years. What is the reason for this? – The large increase in use is mainly due to the treatment of non-approved indications such as sleep difficulties, says Gry Vibeke Bakken. She is a senior adviser at the Institute of Public Health (FHI). Bakken expresses that they are concerned about the increased use. – National guidelines do not recommend the use of antipsychotics to treat insomnia, if there are no specific reasons for this. It can be, for example, with psychotic or bipolar symptoms. – Not a remedy to be used Olav Spigset is a senior physician and professor at St. Olav’s hospital in Trondheim. He is employed at the department of clinical pharmacology. He says Seroquel should not be used as a sleeping aid for the elderly. – You risk side effects, even with low doses. I don’t think this is a means to use to get the old to sleep. Why do you think usage has nevertheless increased? – There has been a lot of talk about this in various environments. It has such an effect that you get tired of it. And it is not associated with the risk of addiction, like traditional sleeping aids. It also takes quite a short time for it to disappear from the body – unlike the old remedies, explains Spigset. But he emphasizes that there is nothing special about research on Seroquel used as a sleeping aid over a long period of time. Erik Grønnestad, on the other hand, has experienced this firsthand. He has used the drug for more than ten years, and believes that it is addictive. Now he wants to warn against the effect. Have tried to quit twice Erik Grønnestad is 53 years old. He was prescribed Seroquel for depression about ten years ago. Among other things, he has used the drug to get to sleep. Now he has tried to quit twice, but says it is very difficult. He believes the drug creates a form of addiction. – In 2018 I got married, and quickly realized that this was not compatible with a family life, so I wanted to quit. After tapering off for about three months, I developed a life-threatening depression. The same thing happened during another attempt in 2020. The first time the wife intervened, he says. – She said I had to start the pills again. And it was like turning on a light switch. After just three days, the depression was forgotten. The 53-year-old says you also experience a form of withdrawal when you taper off the medication. He describes it as a “lightning stroke” in the brain. In addition, it will also lead to insomnia. Several days could pass without him getting any sleep. – For the elderly, who may not be able to communicate the problems that arise as well, I think this can lead to major problems, he says to news. Quetiapine contains the same active ingredients as Seroquel, but is sold by a different pharmaceutical company. Photo: Julie Haugen Egge / news Do you know enough? Chief physician Olav Spigset says that withdrawal, including low mood, has been rarely reported. But he has never before heard that the drug can cause life-threatening depression long after treatment has ended. Nevertheless, he says Seroquel has elements in it that tend towards addiction, even if it does not meet all the criteria. – It can be experienced this way when you use a drug that you cannot stop taking. Because the body adapts to use. And then you can experience unpleasant things, which in turn can feel like a form of withdrawal. Spigset says there are also discussions about other drugs and how addictive they are. – But as of today, professionals have a set of criteria that they use as a basis. The US says no The pharmaceutical company AstraZeneca is behind Seroquel. When asked if they think it is safe to use as a sleeping aid for the elderly, they answer as follows: – Seroquel is not approved for use in sleep problems in Norway or in the EU. Doctors can always consider using a medicine outside the approved indication area, but we as a pharmaceutical company have no role in this. This is stated by Mathias Holm Pedersen. He is the Nordic communications manager in the company. In the United States, the authorities have decided that antipsychotic drugs should not be used among people with dementia or Alzheimer’s disease. Courtney Rhodes is employed by the Food and Drug Administration (FDA). It is an agency within the federal US Department of Health and Human Services. In an e-mail to news, she writes that they already issued a notice in 2008 that the authorities do not approve the use of antipsychotics among dementia patients. The reason is simple: – Both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis, she writes. Differently in Europe, news has also been in contact with the EMA (the European Medicines Agency – an EU agency founded in 1995). Their job is to assess the medicines and determine whether they are safe, effective and manufactured according to the expected standards to be approved in the EU. In an e-mail, they explain that it is up to each individual member state to develop its own guidelines for use and areas of use. But on a general basis, they write that the use of certain antipsychotics, which are approved in the EU, is indicated for the treatment of schizophrenia, bipolar disorder or moderate to severe manic episodes. 10.02.23: In a first version of this case, we wrote in the title that the drug Seroquel was not approved for use among the elderly and people with dementia. This is not correct. It is approved for use in specific patient groups (psychiatric disorders). But it is not approved as a sleeping aid. We have therefore changed the title.
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Researcher and specialist in psychiatry is surprised – news Trøndelag
