Antidepressants Might Accelerate Dementia Decline

TUESDAY, Feb. 25, 2025 (HealthDay news) — Antidepressants are frequently prescribed to people with dementia for symptoms like anxiety, depression, aggressiveness and sleeplessness.

But a specific class of antidepressant medications — selective serotonin reuptake inhibitors (SSRIs) — actually might speed up brain decline among some dementia patients, a new Swedish study suggests.

Heavier doses of certain SSRIs are tied to a higher risk for severe dementia, researchers reported in a new study published Feb. 24 in the journal BMC Medicine.

Taking more than the average amount typically prescribed for these drugs was linked to an additional decline of 0.42 points per year in a dementia scale that runs from 0 to 30, researchers found.

The SSRI drug escitalopram was associated with the fastest cognitive decline, followed by citalopram and sertraline.

Mirtazapine, which works in a different way, had less negative impact on brain function, researchers found.

“Depressive symptoms can both worsen cognitive decline and impair quality of life, so it is important to treat them,” said senior investigator Sara Garcia Ptacek, an assistant professor of neurology at the Karolinska Institute in Solna, Sweden.

“Our results can help doctors and other healthcare professionals choose antidepressants that are better adapted for patients with dementia,” she added in a news release.

For the study, researchers tracked the brain health of more than 18,700 patients enlisted in the Swedish Registry for Cognitive/Dementia Disorders between May 2007 and Oct. 2018. The patients’ average age was 78.

During an average follow-up of more than four years, about 23% of patients received a new prescription for an antidepressant, researchers said.

SSRIs were the most commonly prescribed antidepressant, amounting to 65% of all those prescriptions, the study says.

“Higher dispensed doses of SSRIs were associated with higher risk for severe dementia, fractures, and all-cause mortality,” the researchers concluded. “These findings highlight the significance of careful and regular monitoring to assess the risks and benefits of different antidepressants use in patients with dementia.”

Faster rates of brain decline were observed among men taking antidepressants compared to women, results also show.

However, outside experts warn that caution should be exercised when interpreting these results.

“There are some important limitations that should be considered,” Dr. Prasad Nishtala, a reader in life sciences with the University of Bath in the U.K., said in a news release.

“One major issue is that the severity of depression in dementia patients wasn’t fully accounted for, which has the potential to bias the results,” said Nishtala, who reviewed the findings. “Additionally, there may be a ‘channelling bias,’ meaning that certain antidepressants like citalopram and sertraline might have been more commonly prescribed to patients with severe dementia, which could also bias the results.”

He added that the study suggests that SSRIs like citalopram and sertraline might also speed up cognitive decline.

“However, it doesn’t explain how or why this happens at a biological level,” Nishtala added. “Because of these limitations, the study’s findings should be interpreted with caution and ideally replicated using other real-world data sources.”

More information

Harvard Medical School has more on treating depression and anxiety in dementia.

SOURCE: Springer, news release, Feb. 24, 2025

Source: HealthDay