A recent study suggests that antidepressants might make memory and thinking problems worse for people with dementia.
However, some antidepressants seem to have less harmful effects than others.
These findings could help doctors choose the safest treatment for patients with dementia who also struggle with depression.
Doctors often prescribe antidepressants to people with dementia to help with symptoms like sadness, anxiety, aggression, or sleep problems.
However, new research using data from the Swedish Dementia Registry (SveDem) found that people with dementia who take antidepressants tend to experience faster mental decline than those who do not take these medications.
The study analyzed data from 18,740 dementia patients, with about 23% of them taking antidepressants. Over the study period, doctors prescribed a total of 11,912 antidepressant medications. The most common type was selective serotonin reuptake inhibitors (SSRIs), which made up 65% of all prescriptions.
One of the researchers, Dr. Sara Garcia Ptacek from Karolinska Institutet, explained that depression can make dementia symptoms worse, so treating it is important. However, the results of this study suggest that doctors should be careful when choosing which antidepressant to prescribe to dementia patients.
The study followed patients over time, comparing those who took antidepressants with those who did not. The researchers noticed that patients on antidepressants showed more rapid mental decline. While it is unclear if the drugs themselves caused this decline or if depression played a role, there was still a clear link between antidepressant use and worsening cognition.
Some antidepressants had a stronger effect than others. Among the SSRIs, escitalopram was linked to the fastest mental decline, followed by citalopram and sertraline. Another antidepressant called mirtazapine, which works differently from SSRIs, appeared to have a smaller impact on memory and thinking skills.
The researchers now plan to study whether certain groups of patients, such as those with specific types of dementia, are more or less affected by different antidepressants. Their goal is to provide more personalized treatment options for dementia patients.
Analysis of the Study Findings
This study provides valuable insights into how antidepressants affect dementia patients. Many people with dementia also experience depression, and doctors often prescribe antidepressants to improve their mood and quality of life. However, this research suggests that some of these medications may actually speed up mental decline.
The findings do not mean that all dementia patients should stop taking antidepressants. Instead, they highlight the importance of choosing the right medication. Since some drugs appear to be more harmful than others, doctors can use this information to select safer options, such as mirtazapine, which had a smaller effect on cognitive decline.
It is also important to remember that this was an observational study, meaning it only showed a connection between antidepressant use and faster memory loss—it did not prove that the drugs caused the decline.
Depression itself might also contribute to worsening dementia symptoms. Future research will need to explore this further, especially by studying different types of dementia and how patients respond to various treatments.
For now, the study serves as a reminder that doctors should carefully consider the risks and benefits of antidepressants for dementia patients. Personalized treatment plans may help balance the need to treat depression while minimizing harm to memory and thinking abilities.
The study is published in BMC Medicine.
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