Antidepressants have helped millions of people. But a recent scientific analysis suggests that the benefits of these drugs might come at a high cost for those who have dementia.
Four antidepressants in particular are associated with increased cognitive decline in patients with dementia, according to an analysis of medical data led by researchers at Karolinska Institutet, a medical university in Stockholm, Sweden.
Most of these drugs are in a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant.
The four antidepressants identified in the study as having the strongest association with increased cognitive decline are:
- Escitalopram (also known by brand names like Lexapro), an SSRI
- Citalopram (Celexa), an SSRI
- Sertraline (Zoloft), an SSRI
- Mirtazapine (Remeron), a different type of antidepressant
Escitalopram was associated with the fastest cognitive decline, followed by citalopram and sertraline.
The study findings were based on an analysis of data on more than 18,000 Swedish patients with dementia. Around 23% of these patients received treatment with antidepressants. Those who took the drugs had increased cognitive decline compared to patients who did not.
Over the course of the study, about 12,000 prescriptions for antidepressants were issued, and SSRIs accounted for 65% of them.
The findings could have widespread implications for millions of people. More than 13% of adults in the U.S. have used antidepressants in the past 30 days, based on 2015-2018 data from the Centers for Disease Control and Prevention (CDC).
The researchers note that antidepressants are often prescribed to dementia patients to treat a number of symptoms, including:
- Aggressiveness
- Anxiety
- Depression
- Sleep disturbances
In a summary of the findings, study coauthor Sara Garcia Ptacek — a researcher at the Department of Neurobiology, Care Sciences and Society at Karolinska Institutet — says:
“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 health care professionals choose antidepressants that are better adapted for patients with dementia.”
While the researchers found an association between using these antidepressants and increased cognitive decline in dementia patients, that does not mean the antidepressants directly caused the decline. The summary of the study states that “it is not currently possible to determine whether the cognitive impairment is due to the drugs or to the depressive symptoms themselves.”
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