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Prescribing antidepressants to dementia patients could prove more harm than good

Research published this week in The Lancet shows that two main antidepressants prescribed for dementia patients with depression provide no benefit for the patients yet increased side effects. According to the researchers at the Institute of Psychiatry at King’s College London, the findings suggest that use of the drugs should now be reconsidered. 

Depression is common in dementia, and antidepressants are commonly prescribed for treating depression in dementia patients. The research investigated the effect of two commonly prescribed antidepressants, sertraline and mirtazapine and their effect in treating Alzheimer’s (the most common form of dementia). 

Professor Sube Banerjee at the Institute of Psychiatry at King’s, says: ‘Depression is one of the most important co-morbidities in dementia.  It is a source of great distress yet the treatments we use are not proven.  I wanted to complete a trial that made clear what we should do with respect to the use of antidepressants for depression in dementia.’

The study examined three groups of more than a hundred dementia patients each to compare the effect of treatment with sertraline, mirtazapine and a placebo. The researchers found that at 13 weeks, the three groups displayed similar levels of decreased depression. Neither did the levels of depression between the three groups differ at 39 weeks, suggesting that the antidepressants provided no benefit to the patients. However, levels of depression in patients who had been referred to specialist services decreased at 13 weeks, and remained low thereafter, suggesting that specialist care may be useful in treating depression in dementia patients. 

Moreover, the researchers found that the group treated with the placebo displayed fewer adverse reactions (26%) that participants in the sertraline (43%) or mirtazapine (41%) groups. They also observed that the patients who took the placebo displayed fewer serious adverse reactions. 

Professor Banerjee says: ‘I was surprised by just how unequivocal our findings are. Firstly, our research shows that we need to reconsider whether we should be using antidepressants for treating depression in dementia.  Secondly, our findings suggest that referral and treatment by secondary care really does seem to make a positive difference for people with depression in dementia, meaning that referring dementia patients with depression to specialist services could make a real positive difference.’

The research was funded by the UK National Institute of Health Research HTA Programme. 

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