Research Unveils Connection Between Antidepressants and Cognitive Decline in Dementia Patients

New research indicates that antidepressants might accelerate cognitive decline in individuals with dementia. However, some medications appear to be less harmful than others, which could assist healthcare professionals in making better treatment choices.

Antidepressants are frequently prescribed to alleviate symptoms like anxiety, depression, aggression, and sleep disturbances among people with dementia. Yet, a recent observational study based on the Swedish Dementia Registry (SveDem) reveals that patients treated with antidepressants experience faster cognitive decline than those not taking these medications. This analysis involved an extensive review of registry data encompassing 18,740 participants; approximately one in four were being treated with antidepressants.

During the study period, a total of 11,912 prescriptions for antidepressants were documented, with selective serotonin reuptake inhibitors (SSRIs) making up 65 percent. “Depressive symptoms not only exacerbate cognitive decline but also diminish quality of life. Hence, it’s crucial to treat them effectively,” remarks Sara Garcia Ptacek, a researcher at the Department of Neurobiology, Care Sciences and Society at Karolinska Institutet and the lead author on this study.

Researchers from both Karolinska Institutet and Sahlgrenska University Hospital in Gothenburg have monitored patients’ cognitive progress over time. They’ve compared outcomes between medicated and non-medicated groups, as well as varying types of antidepressants. Although it remains unclear whether the observed decline is due to the drugs themselves or pre-existing depressive symptoms, data showed a correlation between antidepressant use and increased cognitive impairment.

Furthermore, the study highlights distinctions among different medications. The SSRI escitalopram was linked to the most significant cognitive decline, followed by citalopram and sertraline SSRIs. In contrast, mirtazapine, which operates through a distinct mechanism of action, exhibited less negative effects on cognition when compared to escitalopram.

Future research aims to explore whether specific patient groups—such as individuals with particular dementia types or biomarkers—respond better or worse to different antidepressants. The objective is to identify these subgroups for more personalized care solutions,” adds Sara Garcia Ptacek.

This study was financially supported by several organizations, including the Swedish Research Council, Region Stockholm, the Swedish Dementia Association, the Alzheimer’s Foundation and New Innovative Roads Call—an initiative funded privately by families like Leif Lundblad. The researchers have declared no conflicts of interest in this work.