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1 min read
A recent study raises crucial questions about the use of antidepressants in patients with dementia. While some drugs, such as SSRIs, may be linked to greater cognitive decline, others, like mirtazapine, appear to be less harmful. Is it the medication or the depression itself that is responsible for this effect? Experts urge caution and advocate for more personalized treatments
A recent study based on data from the Swedish Dementia Registry (SveDem) suggests that the use of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may be associated with faster cognitive decline in people with dementia. However, the researchers emphasize that it is unclear whether this effect is directly due to the medications or the depressive symptoms they aim to treat.
The study, published in BMC Medicine, analyzed data from 18,740 dementia patients, of whom approximately 23% received antidepressant treatment. During the study period, 11,912 prescriptions were recorded, with SSRIs being the most common (65%). The results showed that patients treated with antidepressants experienced greater cognitive decline compared to those who did not receive this medication.
Among SSRIs, escitalopram was associated with the fastest cognitive decline, followed by citalopram and sertraline. On the other hand, mirtazapine, an antidepressant with a different mechanism of action, showed a less negative impact on cognition.
The researchers also observed that higher doses of SSRIs were linked to an increased risk of severe dementia, fractures, and mortality.
Although the findings are significant, experts caution that they should be interpreted carefully. “We cannot determine whether cognitive decline is caused by antidepressants or by depression itself,” explained Sara Garcia Ptacek, researcher at the Karolinska Institute and lead author of the study. “However, these results may help doctors choose antidepressants better suited for patients with dementia.”
The goal is to identify these subgroups in order to provide more individualized care
The study also highlights the importance of personalizing treatment. The researchers plan to investigate whether certain patient groups, such as those with specific types of dementia or particular biomarkers, respond better or worse to different antidepressants. “The goal is to identify these subgroups in order to provide more individualized care,” added Garcia Ptacek.
Nonetheless, it is important to emphasize the need to consider individual differences among patients. Every person with dementia is unique, and studies like this should be interpreted cautiously to avoid conflating distinct clinical scenarios.
Although antidepressants remain a valuable tool for treating symptoms such as depression and anxiety in patients with dementia, this study suggests that their use should be carefully evaluated, prioritizing options with less cognitive impact and tailoring treatment to the individual needs of each patient.