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- Page navigation anchor for RE: Trazodone vs. Atypicals in patients with DementiaRE: Trazodone vs. Atypicals in patients with Dementia
Thank you for your interest in our manuscript (1). We focused our discussion on the risk of falls and fractures because this was our primary outcome. Interestingly, these outcomes were prioritized over the risk of death by a group of dementia care partners with whom we conducted an outcome prioritization survey. We chose to highlight that medications being used in lieu of antipsychotics for the treatment of neuropsychiatric symptoms in dementia (i.e. antidepressants) are also associated with harms. As clinicians discuss treatment options with patients and their caregivers, we need to ensure that they understand the potential benefits and risks of each treatment.
We do not receive any funding from drug companies. Furthermore, we recently published a study in the Annals of Internal Medicine describing how nonpharmacologic interventions (e.g. massage therapy) and multidisciplinary care work as well or better than medications for reducing symptoms of agitation and aggression in persons living with dementia (2). Given the mounting evidence of harm associated with pharmacologic interventions in persons with dementia, we believe nonpharmacologic interventions and multidisciplinary care should be prioritized; however, clinicians, patients and caregivers need to engage in shared decision-making that considers the unique challenges of each clinical encounter.
(1) Watt JA, Gomes T, Bronskill SE, et al. Comparative risk of harm associated with trazodone or atypical a...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Trazodone vs. Atypicals in patients with DementiaRE: Trazodone vs. Atypicals in patients with Dementia
Letter to the Editor:
The article by Watt et al.1 comparing the risks of trazodone and atypical antipsychotics in patients with dementia seems peculiar to me. The study showed (as have prior studies) that atypical antipsychotics increase the mortality risk. The study also showed that trazodone and atypicals are about equal in terms of the risk of falling and fractures (though mortality in this population was actually considerably more frequent than falls or fractures).
The peculiar part is that the conclusions seem to focus on the fact that trazodone does not decrease the risk of falls and fractures. Trazodone is not without risk in demented patients, but the article does not state the obvious conclusion, that trazodone is preferable to atypicals (in terms of side effects). The study clearly demonstrates that the recent trend the authors mention, that trazodone is being used more in this setting because of the increased mortality with atypicals, is reasonable and appropriate.
I hate to say it, but it seems to me that the focus of this manuscript and its conclusions may have been influenced by drug companies marketing atypicals. Only the authors, or perhaps an investigative journalist, would know. I think this calls for some attention.
1Watt JA, Gomes T, Bronskill SE, et al. Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study. CMAJ 2018;190(47):E13...
Show MoreCompeting Interests: None declared.