Study explores link between antidepressant use and cognitive decline in dementia patients

New research suggests that antidepressants can accelerate the cognitive decline in people with dementia. At the same time, some medicines seem to be less harmful than others, what doctors can help make better treatment decisions, according to the study published in BMC Medicine.

Antidepressants are often used to relieve symptoms such as anxiety, depression, aggressiveness and sleep disorders in patients with dementia.

However, a new observational study based on data from the Swedish dementia register (Svedem) shows that patients with dementia treated with antidepressants experience an increased cognitive decline compared to patients who do not receive this medication.

The study is based on an extensive analysis of register data of 18,740 patients, of whom around 23 percent were treated with antidepressants. During the study, a total of 11,912 recipes antidepressants were registered, with selective serotonin re -admission inhibitors (SSRIS) accounting for 65 percent.

“Depressive symptoms can exacerbate both cognitive decline and the quality of life, so it is important to treat them. Our results can help doctors and other care providers choose antidepressants that are better adapted for patients with dementia,” says Sara Garcia Ptacekk , researcher at the Neurobiology department, Care Sciences and Society, Karolinska Institutet and the last author of the study.

The researchers of Karolinska Institutet and Sahlgrenska University Hospital in Gothenburg have followed the cognitive development of patients over time and compared both medicinal and non-medical groups, as well as different types of antidepressants.

Although it is currently not possible to determine whether the cognitive impairment is due to the medicines or the depressive symptoms themselves, the researchers could see that antidepressants were associated with increased cognitive decline.

Differences between drugs

The study also points to differences between different medicines. The SSRIescitalopram was associated with the fastest cognitive decline, followed by the SSRIS CITALopram and Sertraline.

Mirtazapine, which has a different mechanism of action, had less negative cognitive impact than escitalopram.

The researchers now want to investigate whether certain patient groups, such as people with specific dementia types or biomarkers, respond better or worse to different antidepressants.

The aim is to find these subgroups to create more individualized care. “

Sara Garcia Ptacek, researcher, Neurobiology department, Care Sciences and Society, Karolinska Institutetet

The study was funded by the Swedish research council, Region Stockholm, the Swedish Dementia Research Foundation, the Alzheimer’s Foundation and new innovative roads – a private initiative of the Leif Lundblad family and others. The researchers do not report any conflicts of interest.