Global cognitive effects of second-generation antidepressants in patients with Alzheimer’s disease

By Scott Cunningham, MD, PhD
Published September 27, 2022

Key Takeaways

  • Second-generation anti-depressants were shown to have no effect on cognition and depression in patients with Alzheimer’s disease.

  • Moreover, the duration of anti-depressant use, class of anti-depressant, combined use of anti-depressant with anti-dementia medications, neuropsychiatric symptoms, and severity of Alzheimer’s disease had no impact on the efficacy of second-generation anti-depressants in patients with Alzheimer’s disease.

Putting It Into Practice

Depression accelerates functional decline in patients with Alzheimer’s disease.

Although anti-depressants have been shown to improve symptoms in patients with various co-morbid neurologic and psychiatric disorders, anti-depressants have no apparent effect on depressive symptoms in patients with Alzheimer’s disease. Moreover, anti-depressant use in patients with Alzheimer’s disease is associated with side effects, such as hyponatremia, cardiotoxicity, and bleeding dyscrasias. Nevertheless, prescriptions for anti-depressants in patients with Alzheimer’s disease are on the rise and two-fold higher in age-matched patients without dementia.

Effective treatment of depression in patients with Alzheimer’s disease is important for a number of reasons, not the least of which is the increased mortality rate in patients with co-morbid psychiatric disorders.

Why this study matters

Depression is not only the most common neuropsychiatric disorder among patients with Alzheimer disease, but also a risk factor for dementia and Alzheimer’s disease.

Approximately 50% and 20%-30% of patients with Alzheimer’s disease have depressive symptoms and major depressive disorder, respectively.

Based on a systematic review of the literature (both animal and human studies), there is no evidence that anti-depressants have an effect on depression or cognition in patients with Alzheimer’s disease.

Study design

The literature was searched for studies involving patients with Alzheimer’s disease who were prescribed second-generation anti-depressants, and the effects of the anti-depressant on cognition and depression were determined.

Results and conclusion

Second-generation anti-depressants had no effect on cognition and depression.

The following factors did not alter the results: duration of anti-depressant use; anti-depressant class; combined use of an anti-depressant and anti-dementia medication; neuropsychiatric symptoms; and severity of Alzheimer’s disease.

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