Can Antidepressants Worsen Cognitive Decline in Dementia Patients?

Key Highlights

• A Swedish study found a link between antidepressant use and faster cognitive decline in dementia patients.
• SSRIs like escitalopram were associated with more rapid mental deterioration compared to other antidepressant classes.
• Experts caution the findings show association, not causation, urging personalized treatment approaches.

A new study published in BMC Medicine suggests a potential connection between antidepressant use and accelerated cognitive decline in people with dementia. Conducted by Swedish researchers, the study analyzed data from the Swedish Registry for Cognitive/Dementia Disorders (SveDem), examining 18,740 dementia patients, 23% of whom were prescribed antidepressants.

The study found that patients on antidepressants experienced a 0.30 point faster decline per year on the Mini-Mental State Examination (MMSE) compared to those not taking the medications. Among the different classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs), including escitalopram (Lexapro) and sertraline (Zoloft), showed the strongest link to cognitive deterioration. Conversely, mirtazapine, an atypical antidepressant, was associated with a slower rate of decline.

Should This Change How Doctors Treat Depression in Dementia?

Despite the findings, medical experts stress that the study only establishes an association, not direct causation. Dr. Aanand Naik from UTHealth Houston emphasized the need for further research.

Clinicians are encouraged to adopt a personalized approach to treatment. Non-pharmacological options such as psychotherapy or behavioral therapies should be explored first. If medication is necessary, doctors should closely monitor cognitive function and opt for drugs with a more favorable cognitive profile.

As research continues, balancing effective depression management with dementia care remains crucial. Patients and caregivers are advised to consult healthcare professionals for individualized treatment plans.