Psychotropic medicines

The use of psychotropic medicines, particularly tricyclic antidepressants and antipsychotics, for people with a learning disability is widespread. Often there is no clear indication or review date.

Challenging what has become normal for the person with respect to the medicines they take for so long can unsettle them, their carers and family members who remember what the behaviour was like before the medicine was introduced, and may be reluctant to have any reviewed or taken away. Pharmacy professionals can support them during this withdrawal process by providing accessible information and helping them to feed back to prescribers regarding the results of any changes to medicines.

The use of psychotropic medicines within their licensed indications, for example an antipsychotic to treat schizophrenia, may be appropriate providing regular monitoring and review are in place.

However, the overuse of psychotropic medicines for people with a learning disability is now the subject of scrutiny and review. Research commissioned by NHS England has found that:

• There is a much higher rate of prescribing of medicines associated with mental health disorder among people with a learning disability than the general population, often more than one medicine in the same class, and in the majority of cases with no clear justification
• Medicines are often used for long periods without adequate review
• There is poor communication with parents and carers and between different healthcare providers.

A report by Public Health England, estimates that up to 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant, or both, without appropriate clinical justification.

The STOMPwLD call to action challenges prescribers to review the use of psychotropic medicines for people with a learning disability. This is an important initiative and one that will require careful consideration. Many of these medicines may have been prescribed in the long term and at high dosages and will require careful review and withdrawal.