A large Swedish study has identified a link between antidepressant use and a faster rate of cognitive decline in patients with dementia. While the study reveals an association, researchers emphasize that the underlying cause remains unclear.
Study Involved Thousands of Patients
Researchers at the Karolinska Institutet analyzed data from nearly 18,750 dementia patients over an average of four years. The findings showed that approximately 4,270 individuals receiving antidepressants experienced a cognitive decline of about 0.30 points per year more on a standardized cognitive assessment (MMSE) compared to the control group.
Selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed antidepressants. Within this class, the drug escitalopram appeared to be associated with the most significant decline.
Not All Dementia Types Affected Equally
The analysis revealed notable differences based on dementia subtype. Patients with
* Alzheimer’s dementia
* Lewy body dementia
* Mixed dementia were particularly affected.
Interestingly, in cases of frontotemporal dementia, antidepressant use was associated with a slower rate of decline. The antidepressant group also showed a slightly increased risk of bone fractures.
Do the Pills Cause the Decline?
A central question remains unanswered: Do the medications accelerate cognitive decline, or are they more often prescribed to individuals already experiencing a more rapid progression of the disease and accompanying depression?
Experts caution against drawing premature conclusions. “Depression itself can negatively impact the course of dementia,” noted sources. Abruptly discontinuing necessary therapies would be inappropriate. The study should encourage clinicians to carefully weigh the risks, and benefits.
A Complex Research Landscape
These new data contribute to a complex and sometimes contradictory body of research. Earlier studies have even suggested a protective effect of SSRIs. Current German guidelines recommend mirtazapine or sertraline for depression in dementia, but acknowledge a limited evidence base.
One potential explanation for the conflicting results is that the structural changes in the brain caused by dementia may alter how antidepressants work.
What Does This Mean for Treatment?
Further research is needed to clarify these findings. In the meantime, individualized treatment approaches are gaining prominence. The Swedish results may help guide clinicians toward selecting medications with potentially fewer cognitive side effects.
Professional organizations recommend regularly reviewing the long-term use of antidepressants in dementia patients. The goal is to provide tailored treatment that maintains quality of life without unnecessarily compromising cognitive function.
The study, published in in BMC Medicine, adds to the growing body of evidence suggesting a complex relationship between mental health treatment and cognitive outcomes in dementia. Researchers followed patients’ cognitive development over time, comparing those taking antidepressants with those who were not, as well as different types of antidepressants.
Sara Garcia Ptacek, a researcher at the Department of Neurobiology, Care Sciences and Society at Karolinska Institutet, emphasized the importance of treating depressive symptoms in dementia patients, stating, “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.”
The study involved data from 18,740 patients in the Swedish Dementia Registry (SveDem), with approximately 23 percent receiving antidepressant treatment. A total of 11,912 antidepressant prescriptions were recorded during the study period, with SSRIs accounting for 65 percent of those prescriptions.
