Common emotional medications may speed up psychological decline in people with dementia

According to a new large-scale Swedish study, treatments for millions of patients around the world can be changed, so the decline in cognitive abilities of cognitive patients in dementia seems to be accelerating.

The study, published on BMC Medicine on February 25, tracking nearly 19,000 people with dementia in a few years, found that people taking antidepressants had worsened cognitive function than those who did not receive these drugs quick.

“Depressive symptoms both worsen cognitive decline and can also impair quality of life, so it is important to treat them. Our results can help doctors and other healthcare professionals choose antidepressants that are suitable for people with dementia.

Not all drugs are performed the same

The researchers examined data from the Swedish National Register for Dementia to compare cognitive trajectories between patients receiving antidepressants and those who did not. Of the 18,740 participants, about 23% of the antidepressants were present during the study period.

Especially with findings that some conventional prescription medications seem to be more problematic than others. SSRI etaplan is associated with the fastest decline in cognition, followed by SSRIS Citalopram and Sertraline. Mirtazapine, which acts through different mechanisms, has less negative cognitive effects than edaplan.

This study is one of the most comprehensive analysis to date on how antidepressants affect cognitive function in patients with dementia, followed by cognitive development in patients with cognitive development, from Karolinska Institutet and Sahlgrenska University Hospital Researchers.

Clinical significance

These findings highlight the delicate balance of clinicians when treating depression in patients with dementia. Untreated depression can greatly worsen the quality of life and may accelerate cognitive decline. However, this study suggests that medications used to address depression may lead to faster cognitive deterioration.

The team noted that although they could observe this association, they could not clearly determine whether cognitive impairment stems from the drug itself or potential depressive symptoms designed to be treated.

Higher doses of selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressant category and are associated with an increased risk of severe dementia, experiencing fractures and higher mortality. This dose-response relationship (higher drug doses correlate with worse outcomes) exacerbates causality rather than just coincidence causes.

Careful study

The study drew strength from the Swedish integrated health care registry, which allowed researchers to track participants over a prolonged period of time while considering many factors that could influence cognitive outcomes.

During the follow-up period, the researchers recorded a total of 11,912 antidepressants among the study participants. SSRI is by far the most common, accounting for approximately 65% ​​of all prescriptions.

Apart from the drug category, specific drug choices seem to be important. Direct comparisons between drugs show that patients taking this result have a faster cognitive decline than sertraline, while the impact of cetoyoyoluan is relatively small than previously thought.

The study was designed to allow researchers to analyze not only the presence of the drug, but also the dose effect. Higher doses are consistently associated with faster cognitive decline, especially for SSRI and other antidepressants.

Personalized treatment methods

These findings point to the need for more personalized treatments. The team plans to investigate certain patient populations, such as those with specific dementia types or biomarkers, that respond better or worse to different antidepressants.

“The goal is to find these subgroups to create more personalized care,” Sara Garcia Ptacek said.

This nuanced approach can help clinicians browse complex risk-benefit calculations when treating depression in patients with dementia. Instead of avoiding antidepressants altogether, doctors choose drugs with less cognitive effects or carefully titrated doses to minimize potential harm.

A broader background

There are about 55 million people worldwide, with nearly 10 million new cases diagnosed each year. Depression often occurs concurrently with dementia, affecting up to 50% of patients at some point during the illness.

It is widely stipulated that antidepressants can not only solve depression but also anxiety, aggression and sleep disorders in patients with dementia. These drugs usually work by regulating neurotransmitters in the brain, especially serotonin and norepinephrine.

Although the study raises important questions about antidepressants in dementia, experts warn that patients should not stop prescription medications without consulting their healthcare providers. The risk of untreated depression must be carefully weighed against the potential cognitive impacts highlighted in this study.

The direction of the future

The study represents an important step towards a more tailored treatment approach, but many problems remain unresolved. The researchers acknowledged that their observational study design was unable to determine the establishment of causality, although consistent patterns observed in different analyses enhanced their findings.

Going forward, the team hopes to identify better or worse patient characteristics that may predict responses to different drugs. This accuracy will enable clinicians to better use the most appropriate treatments with their patients, thereby minimizing risks while maximizing benefits.

The research was funded by several organizations, including the Swedish Research Council, Stockholm Region, Swedish Dementia Research Foundation, Alzheimer’s Foundation and New Call for Innovation Roads – Private initiatives from the Leif Lundblad family and others.

As our understanding of the complex interactions between dementia, depression and drug effects continues to evolve, such research provides key guidance for improving care in one of our most vulnerable patient populations.