Treatment with antidepressant medication is linked to a higher rate of cognitive decline in people with dementia.
- A new study investigated the impact of
antidepressants on cognitive decline in dementia patients.
- The researchers studied nearly 19,000 people
diagnosed with dementia, and around 23% received antidepressants as a
treatment for depression.
- The study showed that cognitive decline was
worse in people who took antidepressants than in people who did not take
one.
- The scientists also discovered that certain
types of antidepressants may contribute to faster cognitive decline than
others.
Dementia affects millions of people, and scientists
are working to develop early detection of dementia and more effective
treatments. They are also looking for ways to reduce the severity of symptoms,
including slowing the progression of symptoms.
Researchers based in Sweden recently completed a study
of people diagnosed with dementia.
They examined the role antidepressants may have on dementia symptoms, chiefly
cognitive decline.
The study findings showed that antidepressants may
speed up cognitive decline in these patients. The researchers were careful to
note that depression alone could contribute to the
more rapid cognitive decline, and they also noticed a difference in the decline
depending on the antidepressant that was prescribed. The study appears in
What
is the link between depression and dementia?
Dementia risk increases with age, and according to the
Alzheimer’s disease is the most prevalent form
of dementia. Other dementia types include frontotemporal
dementia and Lewy body dementia.
Some symptoms of dementia include:
- memory loss
- getting locations, dates, and names confused
- changes in mood
- losing items
- difficulty speaking and writing.
There is no cure for
this condition, but between early diagnosis and interventions, providers can
help patients manage symptoms with certain medications and therapies.
Since changes in mood are common with dementia,
depression is common and occurs in an estimated 30 to 50% of people with the
disease.
Doctors often prescribe antidepressants to help manage depression
symptoms. Some popular options are selective serotonin
reuptake inhibitors or SSRIs (sertraline and fluoxetine), tricyclic antidepressants (amitriptyline
and amoxapine), and serotonin-norepinephrine reuptake inhibitors or SNRIs
(duloxetine and desvenlafaxine).
The authors of the new cohort study wanted to find out
whether it is possible for antidepressants and antidepressant classes to impact
the rate of disease progression. They noted that prior studies were limited in
scope and had inconclusive findings and that the clinical efficacy of the
antidepressants was unclear.
The researchers used data from the Swedish Registry for Cognitive/Dementia Disorders (SveDem),
collected between 2007 and 2018, for their analysis. Of the 18,740 dementia
patients included in the study, approximately 23% were on antidepressants.
The participants had a mean age of 78.2 years, and
54.5% of the participants were women. All participants had at least one
follow-up visit after receiving their dementia diagnosis.
To track cognitive changes, the researchers utilized
Mini-Mental State Examination (MMSE) scores that were recorded both at the time
the dementia diagnosis was documented and at follow-ups.
The researchers analyzed not only the rate of
cognitive decline in people who took antidepressants versus those who did not
but the difference in medication classes as well.
The researchers
discovered there may be a link between antidepressant use and an increase in
the rate of cognitive decline in dementia patients. The decline rate for all
categories of antidepressants and all types of dementia on the MMSE screening
was a differential of 0.30 points per year.
Additionally, the scientists found a difference in
cognitive decline depending on the class of antidepressants the participants
took.
People who took SSRIs experienced faster cognitive
decline than people who took SNRIs or tricyclic antidepressants. Mirtazapine (Remeron), an atypical
antidepressant, had a less harmful impact on cognitive functioning.
When
focusing on only mediations in the SSRI class, escitalopram (Lexapro) was linked
to a faster decline than sertraline (Zoloft).
Meanwhile, people who took citalopram (Celexa) experienced a
slower decline.
Also, the researchers found an association between
higher doses of SSRIs and a higher risk of severe dementia, fractures, and
all-cause mortality.
The study further examined factors such as sex and
baseline cognitive function. They found that the effect of antidepressant use
on cognitive decline was more pronounced in men and individuals with lower
baseline MMSE scores.
While these findings demonstrate a possible connection
between taking antidepressants and worse outcomes in dementia, it is important
to note that this is only an association, and more research is needed.
The researchers are unsure whether the medications are the cause of the increased cognitive decline or if it is a matter of depression and other neuropsychiatric issues causing problems.
Approach the study results with caution, experts warn
Aanand Naik, MD, a geriatrician and executive
director of the Institute on Aging at UTHealth Houston, who was not involved in
the research, spoke with Medical
News Today about this study.
Naik advised that further research is necessary before
becoming overly concerned with the findings.
“I would be cautious about overinterpreting these
results,” he emphasized, speaking about the study design:
“The study designs the
authors used is a population-based cohort with trends over time in a large
nationally representative sample. I’m not clear from this study that using
depression medications causes cognitive decline.”
While Naik acknowledged that the study shows cognitive
decline on the MMSE, he thought that “the need for depression medication likely
heralds the onset of worsening behavioral symptoms and progression of
dementia.”
David Merrill, MD, a
board-certified geriatric psychiatrist at Providence Saint John’s Health Center
in Santa Monica, CA, and Singleton Endowed Chair in Integrative Brain Health,
also spoke with MNT to
provide insights on the study.
Merrill, who was likewise not involved in this study,
also emphasized that further research is needed on this topic, but did explain
a reason why patients on antidepressants could have some degree of cognitive
decline.
“One
possibility is that SSRIs may influence neurotransmitter systems in ways that
exacerbate cognitive deterioration,” said Merrill. “Additionally, the
depressive symptoms themselves, which these medications aim to treat, might
inherently contribute to cognitive decline, making it challenging to
disentangle the effects of the medication from the underlying condition.”
When asked whether these findings should influence
clinical practice for prescribing antidepressants in people with dementia,
Merrill advised a “careful, individualized approach.”
“Clinicians should thoroughly assess the severity of
depressive symptoms and consider non-pharmacological interventions, such as
psychotherapy or behavioral therapies, as first-line treatments,” he
recommended. “If antidepressant medication is deemed necessary, selecting
agents with a more favorable cognitive profile and closely monitoring the
patient’s cognitive function over time is essential.
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