Do antipsychotic drugs increase the risk of death for people with dementia?
Antipsychotic drugs are sometimes prescribed to manage agitation, aggression, or psychosis in people with dementia. However, these medications carry serious safety risks, especially for older adults. Research consistently shows that antipsychotics increase the risk of death in people with dementia. This risk applies to both typical (older) and atypical (newer) antipsychotics. Because of this, doctors generally recommend trying non-drug approaches first.
What the research says
A large 2024 systematic review and meta-analysis of 45 studies involving two million participants found that antipsychotic use in people with dementia was linked to a 32% higher risk of death (pooled hazard ratio 1.32) 1. This increased risk was seen for both typical and atypical antipsychotics. The review also noted that international guidelines recommend non-drug treatments as the first choice for managing behavioral symptoms 1.
A 2021 Cochrane review of randomized trials on antipsychotics for agitation and psychosis in Alzheimer's and vascular dementia concluded that the benefits of these drugs are uncertain and may be outweighed by harms 10. The review highlighted safety concerns, including increased mortality.
Another 2025 study specifically looked at low-dose quetiapine (a common antipsychotic) used for insomnia in older adults. It found that even at low doses, quetiapine was associated with a higher risk of death compared to other sleep medications like trazodone or mirtazapine 11. This suggests the mortality risk is not limited to higher doses or dementia-specific use.
A 2020 review on delirium in hospitalized older adults noted that while antipsychotics are sometimes used off-label for severe agitation, there is a lack of strong evidence supporting their use, and they carry risks including increased mortality 9.
What to ask your doctor
- What non-drug approaches can we try first to manage my loved one's agitation or psychosis?
- If an antipsychotic is recommended, what specific risks should we watch for, including the risk of death?
- Are there safer medication alternatives, such as certain antidepressants or mood stabilizers, that might help?
- How will the lowest effective dose be determined, and how often will the need for the medication be reassessed?
- What signs of serious side effects (like drowsiness, falls, or confusion) should prompt an immediate call to the doctor?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.