ObjectiveTo determine the pattern of use of psychotropic drugs in Sydney nursing homes.DesignSurvey of data from medical records of residents and interviews with residents and staff.SettingCentral Sydney Health Area, June to December 1993.Participants: All residents of 46 of the 47 nursing homes in the western sector of the health area.Main outcome measuresPsychotropic drugs used regularly or as required. Degree of cognitive impairment and depression rated on interview with residents, using Mini‐Mental State Examination and Geriatric Depression Scale. Behavioural disturbances reported by staff.Results: Most residents (58.9%) were taking one or more psychotropic drugs regularly and another 7% were prescribed these drugs as required. Neuroleptics were taken regularly by 27.4% and as required by a further 1.4% (at least one dose in the previous four weeks), but doses were equivalent to more than 100 mg/day of chlorpromazine for only 8.8%. Neuroleptics were more likely to be given to residents with greater cognitive impairment and more disturbed behaviour. Other psychotropic drugs in regular use were: benzodiazepines (32.3%); hypnotics (26.6%); antidepressants (15.6%); and anxiolytics (8.6%). At least half of antidepressant doses were subtherapeutic. Of 874 residents who responded to a depression questionnaire, 30% scored as significantly depressed; one‐third of these were taking antidepressants.ConclusionsThe percentage of residents in Central Sydney nursing homes who were taking neuroleptics, hypnotics or anxiolytics is among the highest reported from geriatric institutions around the world. Prescribing practices in Australian nursing homes need to be reviewed.