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A recent study suggests that antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may be linked to faster cognitive decline in individuals with dementia. However, experts caution against drawing definitive conclusions, emphasizing the need for further research.
Key Findings The study, published in BMC Medicine on February 24, analyzed data from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Researchers examined 18,740 patients newly diagnosed with dementia, tracking their cognitive trajectories over an average follow-up of 4.3 years.
Among these patients, 23% received new prescriptions for antidepressants, with SSRIs being the most commonly prescribed (65%). The study found that antidepressant use was associated with an overall decline in Mini-Mental State Examination (MMSE) scores of 0.30 points per year. Notably, different SSRIs had varying effects on cognitive decline:
- Sertraline: 0.25 points/year
- Citalopram: 0.41 points/year
- Escitalopram: 0.76 points/year
- Mirtazapine (a tetracyclic antidepressant): 0.19 points/year
Higher daily doses of SSRIs were linked to increased cognitive decline, as well as a higher risk of severe dementia, fractures, and all-cause mortality.
Interpreting the Results Despite these findings, the study authors and independent experts stress the need for caution. Corresponding author Sara Garcia-Ptacek, MD, PhD, of Karolinska Institutet, emphasized that it would be “premature” to alter existing clinical recommendations. She noted the importance of further research comparing antidepressants and personalizing treatment based on genetic factors.
Experts also pointed out potential confounding factors. Ipsit Vahia, MD, from Harvard Medical School, highlighted that the study relied on an existing database and could not fully differentiate between depression and mild behavioral impairment, which may not respond to antidepressants.
Emma Anderson, PhD, from University College London, noted the risk of “confounding by indication,” where the severity of depression in dementia patients wasn’t fully accounted for. Similarly, Prasad Nishtala, PhD, from the University of Bath, raised concerns about “channeling bias,” where certain antidepressants might have been more commonly prescribed to patients with severe dementia.
Moreover, the study did not explore the biological mechanisms behind the potential link between SSRIs and cognitive decline, making it difficult to establish causation.
Clinical Implications While the study raises important questions, its findings do not warrant immediate changes in prescribing practices. Experts recommend an individualized approach to treatment, weighing the benefits and risks of antidepressant use in dementia patients.
Garcia-Ptacek advised that sertraline and mirtazapine may still be reasonable choices for patients needing antidepressants, given their relatively smaller impact on cognitive decline.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Patients and caregivers should consult healthcare professionals before making any changes to medication or treatment plans.
