[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 9, April 2012].
Roughly 80% of nursing home residents have dementia in Norway. 90% have neuropsychiatric symptoms. Roughly 40% of residents in Norwegian nursing homes are prescribed antidepressants. There are potential harms arising from use of antidepressants, so this study examined the effects of withdrawing from antidepressants in relation to depressive symptoms, neuropsychiatric symptoms, and other side effects in 128 Norwegian nursing homes residents with Alzheimer’s disease, dementia or vascular dementia. The residents had neuropsychiatric symptoms (but not depression) and had been prescribed escitalopram, citalopram, sertraline, or paroxetine for 3 months or more. Antidepressant treatment was discontinued in 63 of these patients over one week, but continued for 68 patients. Patients were re-assessed at 4, 7, 13, and 25 weeks.
Outcomes after 25 weeks showed that residents who stopped taking antidepressants had higher scores on the Cornell scale of depression in dementia and (to a lesser extent) on the neuropsychiatric inventory. The condition of more patients was found to have worsened in the discontinuation group than in the continuation group.
The patients who discontinued their treatment with escitalopram, citalopram, sertraline, or paroxetin showed a statistically significant increase in depressive symptoms; while those who continued antidepressant treatment had a smaller (non-significant) decrease in such symptoms after 25 weeks.
The authors suggest that worsening depressive symptoms after discontinuation indicates that antidepressants are probably effective in patients with dementia and neuropsychiatric symptoms. Equally, some patients can tolerate withdrawal of antidepressants without adverse effects.
The authors conclude that “although antidepressants could be discontinued in most patients with dementia, these patients should be monitored carefully to identify those with worsening depressive symptoms”.
Bergh, S. Selbæk, G. [and] Engedal, K. (2012). Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double-blind, randomised, parallel group, placebo controlled trial. BMJ (Clinical research ed.), March 12th 2012, Vol.344, e1566. (Click here to view the PubMed abstract).
August 2018 Update
A Taiwanese meta-analysis confirms that antidepressant use in elderly patients is associated significantly with an increased risk of developing dementia:
Wang, YC. Tai, PA. [and] Poly, TN. [et al] (2018). Increased risk of dementia in patients with antidepressants: a meta-analysis of observational studies. Behavioural Neurology. July 10th 2018; 5315098.