This randomised control trial took place across nine English old-age psychiatry units. It examined the clinical effectiveness of sertraline and mirtazapine in reducing depression compared with a placebo. 326 patients with Alzheimer’s Disease (AD), depression and a Cornell Scale for Depression in Dementia (CSDD) score of 8 or higher, received either 150 mg sertraline or 45 mg mirtazapine daily (or a placebo). No statistically significant differences in CSDD scores were detected between the different groups after 13 weeks. There were fewer adverse reactions in the placebo group, and mortality was equal for all patient groups.
This suggests that the antidepressants tested are not clinically effective for treating depression in AD. An early outline preview of this research was published initially in the Lancet in 2011.
It is concluded that antidepressants should not be the first-line treatment of depression in AD, although the authors recommend a further placebo-controlled trial to investigate the clinical effectiveness and cost-effectiveness of mirtazapine for the management of Behavioural and Psychological Symptoms of Dementia.
More research is required into alternative biological and psychological therapies for depression in dementia; and into the “natural history” of depression in dementia in the community when patients are not referred to secondary care. Trials of new medications for the treatment of depression in dementia should be tested against a placebo in future.
Further research is required into the impact of treatments for depression in people with dementia on carers, with respect to their quality of life, the time they spend care-giving and other aspects of the carer burden.
Banerjee, S. Hellier, J. Romeo, R. [et al]. (2013). Study of the use of antidepressants for depression in dementia: the HTA-SADD trial: a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technology Assessment. February 2013; 17(7), 1-166. Click here to view the HTA abstract.
There is also an Executive Summary.
[A brief reference to this item features in Dementia and Elderly Care: the Latest Evidence Newsletter (RWNHST), Volume 3 Issue 7, May 2013].