Antidepressants for treating depression in dementia

Abstract

The use of antidepressants for patients with dementia accompanied by depressive symptoms is widespread, but their clinical efficacy is uncertain. Many of the individual trials of antidepressants have been too small to provide precise estimates of the moderate benefits that might realistically be expected. Combining the information from all appropriate trials may provide a better estimate of the likely effects of treatment.Objectives To determine whether antidepressants are clinically effective and acceptable for the treatment of patients with depression and also dementia.Search methods The CDCIG Specialized Register was last searched on 27 April 2005. This register contains records from major health care databases and many ongoing trials databases and is updated regularly.Medical information departments of pharmaceutical companies were asked to search their databases for any relevant clinical trials. Where necessary authors of trials were approached with requests for additional information.Selection criteria All relevant unconfounded, double-blind, randomized trials comparing any antidepressant drug with placebo, for patients diagnosed as having dementia and depression, according to established criteria.Data collection and analysis Two reviewers extracted data independently and settled any differences by agreement.Main results There were seven included studies with a total of 1140 subjects of which 769 met inclusion criteria. Four included studies reported sufficiently detailed results to enter into meta-analyses, with a total of 137 subjects. Two of these studies investigated the properties of drugs not commonly used in this population with only two studies (Petracca 2001 and Lyketsos 2003) using the more common selective serotonin reuptake inhibitors (SSRIs). Lyketsos 2003 produced two significant differences in favour of treatment in the Cornell Scale for Depression in Dementia (CSDD) at 12 weeks and in the psychiatrists' global rating. However, the CSDD was not used in any of the other studies and no statistical differences were found with the other measures used in the meta-analysis. The meta-analysis of the number of patients suffering at least one adverse event, one event of the nervous system, one event of the gastrointestinal system and one event of dry mouth at 6 to 12 weeks showed a significant difference in favour of placebo. There were no other significant results.Authors' conclusions Available evidence offers weak support to the contention that antidepressants are effective for patients with depression and dementia.However, only four studies are included in the meta-analysis relating to efficacy, and sample sizes are small.Moreover, only two included studies investigated the properties of the more commonly used SSRIs and no studies investigated the properties of newer classes of antidepressants (e.g. selective noradrenergic reuptake inhibitors). This review draws attention to the paucity of research and evidence in this area.

Systematic review of recent dementia practice guidelines

“…[203][204] Evidence for use of older tricyclic antidepressants (clomipramine and imipramine) is weak. 203 Selective serotonin reuptake inhibitor's (SSRIs) which are commonly used to treat depression in the elderly does not appear effective in the treatment of neuropsychiatric symptoms of dementia other than depression. [203][204] …”

Evidence-Based Pharmacologic Interventions for Geriatric Depression

“…This review focuses on recent geriatric studies examining the comparative efficacy of SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs). The reader is referred elsewhere to recent meta-analyses [43][44][45][46] and systematic reviews [47][48][49] for comprehensive assessments of the effectiveness of TCAs and other agents in the treatment of geriatric depression [46].…”

Prospective cohort studies in dementia

“…While the fi nding that survival of those with Alzheimer ' s dementia was not directly related to the consumption of antipsychotic or antidepressant medication is reassuring, this should not be interpreted as indicating a need for lowered vigilance and caution in the prescribing of these medications to people with Alzheimer ' s dementia. Evidence for effi cacy indicates modest or no benefi t for these treatments (Bains et al, 2002;Brodaty et al, 2003;Banerjee et al, 2011) and even if they are not directly associated with earlier death in this cohort, their potential to affect quality of life by causing side effects such as Parkinsonism or sedation, should not be overlooked.…”