The use of antidepressants may worsen cognitive decline in patients with dementia, with certain drugs causing more harm than others, a recent study revealed.
Although experts have conflicting views on this surprising finding, the researchers hope their study will help doctors and patients make informed choices when making treatment decisions.
In the latest study published in BMC Medicine, researchers followed up 18,740 patients newly diagnosed with dementia for an average of 4.3 years. During this time, 23% of the patients were prescribed antidepressants, with 65% of those receiving selective serotonin reuptake inhibitors (SSRIs), a commonly used class of antidepressants.
To examine whether antidepressant use, particularly SSRIs, had any correlation with worsening cognitive decline in these patients, they assessed the participant’s cognitive health by using Mini-Mental State Examination (MMSE) scores.
The findings revealed a troubling connection between higher doses of SSRIs and an increased risk of severe dementia, fractures, and all-cause mortality. Among the different SSRIs, escitalopram (sold as Lexapro) was linked to the most rapid cognitive decline, followed by citalopram (Celexa) and sertraline (Zoloft).
“Depressive symptoms can both worsen cognitive decline and impair quality of life, so it is important to treat them. Our results can help doctors and other healthcare professionals choose antidepressants that are better adapted for patients with dementia,” said Sara Garcia Ptacek, the study’s last author in a news release.
The study highlights the need for doctors to weigh the potential benefits of antidepressants against the possible harm they may cause in vulnerable populations.
“When patients have severe symptoms of anxiety or depression, antidepressants are sometimes very useful and necessary. I think our findings can guide choice of antidepressant, although this was a cohort study, and it is hard to infer causation,” said Garcia-Ptacek.
However, the study’s results should be viewed with caution, as it remains unclear whether the cognitive decline was directly caused by the antidepressants or whether it was influenced by other factors, such as the depressive symptoms themselves.
Pointing out potential limitations of the study, Dr. Prasad Nishtala, Reader at the University of Bath, noted that the study failed to fully account for factors such as the severity of depression in dementia patients, which could bias the results.
“Additionally, there may be a “channeling bias,” meaning that certain antidepressants like citalopram and sertraline might have been more commonly prescribed to patients with severe dementia, which could also bias the results,” Dr. Nishtala said.
