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Sultan S. Treating Depression in Dementia Patients: A Risk or Remedy-A Narrative Review. Geriatrics (Basel) 2024; 9:64. [PMID: 38804321 PMCID: PMC11130822 DOI: 10.3390/geriatrics9030064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/15/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The diagnosis of depression in dementia patients leads to an increase in the burden of the disease. To treat depression in this patient group, antidepressants are frequently used; however, there is not any proof of their therapeutic effectiveness, and their use may be potentially harmful. This narrative review aims to summarize the existing evidence regarding the role of antidepressants in treating depression in dementia patients. MAIN TEXT A search was conducted in the PubMed, Excerpta Medica database (EMBASE), and Cochrane databases for randomized controlled trials and meta-analyses wherein antidepressants were given to dementia sufferers to address depression. Fifteen randomized controlled trials and seven meta-analyses were identified. Most well-designed blinded placebo-controlled trials reported a lack of effectiveness of antidepressants in treating depression in dementia patients. Among the seven metanalyses, two reported good efficacy of Selective serotonin reuptake inhibitors (SSRIs). However, two major Cochrane reviews reported little or no effectiveness and increased side effects of antidepressants in dementia patients. CONCLUSION There is robust evidence regarding the lack of efficacy of antidepressants in treating depression in dementia patients. However, further well-designed Randomized controlled trials (RCTs,) using scales with good validity and reliability to diagnose depression in dementia patients, sufficient sample sizes, and detailed adverse effect profiles may help determine the rationale for their use.
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Affiliation(s)
- Sadia Sultan
- Clinical Sciences Department-MBBS Program, Fakeeh College for Medical Sciences, Jeddah 21461, Saudi Arabia
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Zhang J, Zheng X, Zhao Z. A systematic review and meta-analysis on the efficacy outcomes of selective serotonin reuptake inhibitors in depression in Alzheimer's disease. BMC Neurol 2023; 23:210. [PMID: 37259037 DOI: 10.1186/s12883-023-03191-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Depressive symptoms are the most common neuropsychiatric symptoms in patients with Alzheimer's disease (AD). However, despite being common, no definite consensus recommendations exist for the management of depression in AD. OBJECTIVE To assess the effects of selective serotonin reuptake inhibitors (SSRIs) on the alleviation of depressive symptoms in patients with AD. MATERIAL AND METHODS Medline, Scopus, Web of Science, Google Scholar, and PsychINFO were electronically searched from inception until October 2022. Response to therapy and mean depression scores between the treatment (or before) and placebo (or after) groups were the primary outcomes. For depression scores, the standard mean deviation and accompanying 95% confidence interval were determined. The risk of bias was determined using the funnel plot, trim and fill, Egger's and Begg's analyses. RESULTS SSRIs attenuated depressive symptoms in patients with AD (0.905 SMD, 95%CI, 0.689 to 1.121, p < 0.000). At individual SSRI level, escitalopram, paroxetine, and sertraline significantly alleviated depressive symptoms in AD patients (0.813 SMD, 95%CI, 0.207 to 1.419, p = 0.009, 1.244 SMD, 95%CI, 0.939 to 1.548, p < 0.000, and 0.818 SMD, 95%CI, 0.274 to 1.362, p < 0.000). The funnel plot, trim and fill, Begg's test (p = 0.052), and Egger's test (p = 0.148), showed no significant risk of publication bias. CONCLUSION Our meta-analysis supports the use of SSRIs for the alleviation of depression in patients with AD. However, we recommend larger randomized clinical trials that would compare the efficacy of different SSRIs in AD patients with depression.
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Affiliation(s)
- Jinli Zhang
- Department of Pharmacy, Tianjin Second People's Hospital, Tianjin, China
| | - Xiaohui Zheng
- Department of Pharmacy, Tianjin Union Medical Center, Tianjin, China
| | - Zhenying Zhao
- Department of Pharmacy, Tianjin Union Medical Center, Tianjin, China.
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Abdeljalil AB, de Mauléon A, Baziard M, Vellas B, Lapeyre-Mestre M, Soto M. Antidepressant Use and Progression of Mild to Moderate Alzheimer's Disease: Results from the European ICTUS Cohort. J Am Med Dir Assoc 2020; 22:433-439. [PMID: 32736994 DOI: 10.1016/j.jamda.2020.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) are a core and troubling feature among patients with Alzheimer disease (AD). Because of growing safety warnings against antipsychotics, the use of antidepressants (ATD) in AD has increased extensively. We investigated the potential long-term associations between ATD exposure and functional and cognitive progression in patients with mild to moderate AD. DESIGN Two-year prospective multicenter cohort ICTUS (Impact of Cholinergic Treatment USe) study with biannual assessments. SETTING Twenty-nine memory clinics from 12 European countries. PARTICIPANTS Community-dwelling patients with mild to moderate AD. METHODS Global cognitive function was measured using the Mini Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Functional impairment was measured using the Activities of Daily Living (ADL). Assessments were performed biannually for 2 years. Antidepressant exposure was defined by an ATD prescription for a minimum period of 6 months. Linear mixed models were used to study the associations between ATD exposure and cognitive and functional progression. RESULTS Antidepressant exposure was not associated with cognitive decline [MMSE: β-coefficients of the linear mixed models (Coef) = 0.06, 95% confidence interval (CI) -0.65 to 0.76, P = .87; ADAS-Cog: Coef = -13.9, 95% CI -34.80 to 7.03, P = .19] or with functional decline (ADL: Coef = -0.05, 95% CI -0.21 to 0.09, P = .48) at 2-year follow-up. Antipsychotic exposure at baseline was associated with a greater functional decline in the ADL score (Coef = -0.39, 95% CI - 0.68 to 0.10, P < .01). CONCLUSIONS AND IMPLICATIONS Antidepressant exposure was not associated with a faster rate of cognitive or functional decline in patients with mild to moderate AD. Antidepressants might be appropriate alternatives to antipsychotics in the management of NPS in mild to moderate AD.
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Affiliation(s)
- Anne-Bahia Abdeljalil
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France.
| | - Adélaïde de Mauléon
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France
| | - Marion Baziard
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France
| | - Bruno Vellas
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France
| | - Maryse Lapeyre-Mestre
- University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Maria Soto
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France
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Pirker-Kees A, Dal-Bianco P, Schmidt R. Effects of Psychotropic Medication on Cognition, Caregiver Burden, and Neuropsychiatric Symptoms in Alzheimer’s Disease over 12 Months: Results from a Prospective Registry of Dementia in Austria (PRODEM). J Alzheimers Dis 2019; 71:623-630. [DOI: 10.3233/jad-181102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Agnes Pirker-Kees
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics and Division of General Neurology, Department of Neurology, Medical University Graz, Graz, Austria
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Hessmann P, Zeidler J, Stahmeyer J, Eberhard S, Vogelgsang J, Abdel-Hamid M, Wolff-Menzler C, Wiltfang J, Kis B. Claims Data Analysis on the Dispensing of Tricyclic Antidepressants Among Patients With Dementia in Germany. Front Pharmacol 2019; 10:841. [PMID: 31396091 PMCID: PMC6667932 DOI: 10.3389/fphar.2019.00841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/01/2019] [Indexed: 12/21/2022] Open
Abstract
Objective: A restrictive use of tricyclic antidepressants (TCA) in patients with dementia (PwD) is recommended due to the hazard of anticholinergic side effects. We evaluated the frequency of TCA dispensing in PwD over a period of 1 year and the use of TCA before and after the incident diagnosis of dementia. Methods: This analysis was based on administrative data from a German statutory health insurance for a period of 2 years. Totally, 20,357 patients with an incident diagnosis of dementia in 2014 were included. We evaluated the dispensing of TCA in 2015. Subgroup analyses were conducted to evaluate associations between the incident diagnosis of dementia and modifications in TCA dispensing. Results: In 2015, 1,125 dementia patients (5.5%) were treated with TCA and 31% were medicated with TCA in all four quarters of 2015. Most dispensings were conducted by general practitioners (67.9%). On average, patients received 3.7 ± 2.6 dispensings per year. Amitriptyline (56.3%), doxepin (26.8%), and trimipramine (16.8%) were dispensed most often. Subgroup analyses revealed that the dispensing of TCA remained mainly unchanged following the incident diagnosis. Conclusion: A relevant number of PwD were treated with TCA. To maintain the patients’ safety, an improved implementation of guidelines for the pharmaceutical treatment of PwD in healthcare institutions might be required. Since 68% of the patients suffered from depression, future studies should further evaluate the indications for TCA.
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Affiliation(s)
- Philipp Hessmann
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.,Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Jona Stahmeyer
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Sveja Eberhard
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Jonathan Vogelgsang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
| | - Claus Wolff-Menzler
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany.,iBiMED, Medical Science Department, University of Aveiro, Aveiro, Portugal
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
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Kettunen R, Taipale H, Tolppanen AM, Tanskanen A, Tiihonen J, Hartikainen S, Koponen M. Duration of new antidepressant use and factors associated with discontinuation among community-dwelling persons with Alzheimer’s disease. Eur J Clin Pharmacol 2018; 75:417-425. [DOI: 10.1007/s00228-018-2591-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
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Orgeta V, Tabet N, Nilforooshan R, Howard R. Efficacy of Antidepressants for Depression in Alzheimer's Disease: Systematic Review and Meta-Analysis. J Alzheimers Dis 2018; 58:725-733. [PMID: 28505970 PMCID: PMC5467718 DOI: 10.3233/jad-161247] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Depression is common in people with Alzheimer’s disease (AD) affecting overall outcomes and decreasing quality of life. Although depression in AD is primarily treated with antidepressants, there are few randomized controlled trials (RCTs) assessing efficacy and results have been conflicting. Objectives: To systematically review evidence on efficacy of antidepressant treatments for depression in AD. Methods: Systematic review and meta-analysis of double blind RCTs comparing antidepressants versus placebo for depression in AD. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Controlled Trials Register and on line national and international registers. Primary outcomes were treatment response and depressive symptoms. Secondary outcomes were cognition, acceptability, and tolerability. Risk of bias was also assessed. Results: Seven studies met inclusion criteria. Three compared sertraline with placebo; one compared both sertraline and mirtazapine to placebo; imipramine, fluoxetine, and clomipramine were evaluated in one study each. In terms of response to treatment (6 studies, 297 patients treated with antidepressants and 223 with placebo), no statistically significant difference between antidepressants and placebo was found (odds ratio (OR) 1.95, 95% CI 0.97–3.92). We found no significant drug-placebo difference for depressive symptoms (5 studies, 311 patients, SMD –0.13; 95% CI –0.49 to 0.24). Overall quality of the evidence was moderate because of methodological limitations in studies and the small number of trials. Conclusion: Despite the importance of depression in people with AD, few RCTs are available on efficacy of antidepressants, limiting clear conclusions of their potential role. There is a need for further high quality RCTs.
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Affiliation(s)
- Vasiliki Orgeta
- Correspondence to: Dr. Vasiliki Orgeta, Alzheimer’s Society Senior Fellow, Senior Research Associate, University College London, Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Tel.: +44 020 7679 9294; Fax: +44 020 7679 9426; E-mail:
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Caselli RJ, Langlais BT, Dueck AC, Henslin BR, Johnson TA, Woodruff BK, Hoffman-Snyder C, Locke DEC. Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment. J Am Geriatr Soc 2018; 66:671-678. [PMID: 29341070 DOI: 10.1111/jgs.15182] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Behavioral problems in individuals with Alzheimer's disease (AD) impose major management challenges. Current prevention strategies are anchored to cognitive outcomes, but behavioral outcomes may provide another, clinically relevant opportunity for preemptive therapy. We sought to determine whether personality changes that predispose to behavioral disorders arise during the transition from preclinical AD to mild cognitive impairment (MCI). DESIGN Longitudinal observational cohort study. SETTING Academic medical center. PARTICIPANTS Members of an apolipoprotein E (APOE) ɛ4 genetically enriched cohort of Maricopa County residents who were neuropsychiatrically healthy at entry (N = 277). Over a mean interval of 7 years, 25 who developed MCI and had the Neuroticism, Extraversion, and Openness Personality Inventory-Revised (NEO-PI-R) before and during the MCI transition epoch were compared with 252 nontransitioners also with serial NEO-PI-R administrations. INTERVENTION Longitudinal administration of the NEO-PI-R and neuropsychological test battery. MEASUREMENTS Change in NEO-PI-R factor scores (neuroticism, extraversion, openness, agreeableness, conscientiousness) from entry to the epoch of MCI diagnosis or an equivalent follow-up duration in nontransitioners. RESULTS NEO-PI-R neuroticism T-scores increased significantly more in MCI transitioners than in nontransitioners (mean 2.9, 95% confidence interval (CI) = 0.9-4.9 vs 0, 95% CI = -0.7-0.7, P = .02), and openness decreased more in MCI transitioners than in nontransitioners (-4.8, 95% CI = -7.3 to -2.4 vs -1.0, 95% CI = -1.6 to -0.4, P < .001). Concurrent subclinical but statistically significant changes in behavioral scores worsened more in MCI transitioners than nontransitioners for measures of depression, somatization, irritability, anxiety, and aggressive attitude. CONCLUSION Personality and subclinical behavioral changes begin during the transition from preclinical AD to incident MCI and qualitatively resemble the clinically manifest behavioral disorders that subsequently arise in individuals with frank dementia.
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Affiliation(s)
| | - Blake T Langlais
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Amylou C Dueck
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bruce R Henslin
- Department of Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Travis A Johnson
- Department of Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bryan K Woodruff
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Dona E C Locke
- Division of Psychology, Mayo Clinic Arizona, Scottsdale, Arizona
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