The relationship between antidepressant use and cognitive decline in dementia patients has garnered increasing attention in recent years. A recent study published in BMC Medicine by Garcia-Ptacek analyzed data from 18,740 dementia patients and revealed a significant link between the use of certain antidepressants and accelerated cognitive decline. The researchers noted that individuals taking drugs such as escitalopram, citalopram, and sertraline exhibited faster cognitive deterioration compared to those who were not prescribed these medications. While the study suggests a correlation, it does not establish causality; the underlying depression itself may be contributing to the observed decline.
A new population-based study led by researchers from the Karolinska Institutet in Sweden has found a common first-line class of medications prescribed to dementia patients for depression could be hastening their cognitive decline, while also putting individuals at greater risk of fractures and an earlier death.
Though other factors can't be conclusively ruled out, the possibility that some antidepressants might worsen an underlying condition may be important for medical specialists treating dementia patients to consider.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are considered the first choice in antidepressants thanks to having relatively few side effects. Yet recent research has identified an association between the inhibitors and an increased risk of dementia in older adults, compared with psychotherapy.
In the latest study, published in BMC Medicine, the researchers investigated how dementia was connected with antidepressant use, analysing the records of nearly 19,000 dementia patients, tracked for about a decade.
They found that the cognitive abilities of those taking an antidepressant worsened slightly faster than those of people who weren’t on any such medication.
This could be because some SSRI antidepressants may block the actions of a brain signalling molecule called acetylcholine, said Dr Sara Garcia-Ptacek, a neurologist at the Karolinska Institute in Stockholm, who led the research.
The analysis is subject to confounding by indication, meaning the associations that emerged in this study may be due to depression rather than antidepressant drugs, Garcia Ptacek and colleagues acknowledged.
The researchers also did not have information about the severity of depression or actual intake of antidepressants, only dispensation data. Dementia severity could independently contribute to cognitive decline, making it difficult to tease apart associations due to depression or antidepressant use.
Conversely, another prospective cohort study found no overall association between antidepressant use and dementia risk or cognitive decline . Although tricyclic antidepressants exhibited a slightly elevated risk of dementia compared to non-users, selective serotonin reuptake inhibitors did not show any significant adverse effects in this regard. These conflicting results emphasize the need for further longitudinal studies to clarify the complex dynamics between antidepressant therapy and cognitive health in dementia patients.
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