Antidepressants in Dementia: A Risk for Rapid Cognitive Decline?

Antidepressants are often prescribed to individuals with dementia to help manage symptoms such as anxiety, depression, aggression, and insomnia. A recent Swedish study suggests that a specific class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), could potentially accelerate brain decline in some dementia patients (1^✔ ✔Trusted Source
Antidepressant use and cognitive decline in patients with dementia: a national cohort study

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Dose-Dependent Cognitive Decline in Dementia Patients

Researchers reported in a study published in BMC Medicine that higher doses of certain SSRIs are linked to an increased risk of severe dementia. Taking more than the typical prescribed dose of these drugs was associated with an additional decline of 0.42 points per year on a dementia scale ranging from 0 to 30.

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Impact of Different Antidepressants on Brain Function

The SSRI drug escitalopram was linked to the fastest cognitive decline, followed by citalopram and sertraline. In contrast, mirtazapine, which works differently, had a less negative impact on brain function, researchers found.

"Depressive symptoms can worsen cognitive decline and impact quality of life, so it's crucial to treat them, our results can help doctors and healthcare professionals select antidepressants that are better suited for patients with dementia," said a senior investigator.

Antidepressant Use in Dementia: Prescription Trends

For the study, researchers monitored the brain health of over 18,700 patients from the Swedish Registry for Cognitive/Dementia Disorders between May 2007 and October 2018. The average age of the patients was 78.

During an average follow-up of over four years, about 23% of patients were prescribed a new antidepressant, according to researchers. SSRIs were the most commonly prescribed, accounting for 65% of all prescriptions in the study.

"Higher doses of SSRIs were linked to an increased risk of severe dementia, fractures, and all-cause mortality," the researchers concluded. "These findings emphasize the need for careful and regular monitoring to evaluate the risks and benefits of antidepressant use in patients with dementia."

The study also found that men experienced faster rates of brain decline while taking antidepressants compared to women.

However, outside experts caution that these results should be interpreted carefully. "There are some important limitations that should be considered," said an expert from the University of Bath in the U.K., in a news release.

According to a reviewer, “One major issue is that the severity of depression in dementia patients wasn’t fully accounted for, which could bias the results.”

“The study suggests SSRIs like citalopram and sertraline might also accelerate cognitive decline.”

In conclusion, while SSRIs are commonly prescribed to dementia patients, higher doses may speed up cognitive decline, especially with drugs like escitalopram. It’s important for doctors to carefully monitor treatment, but experts also caution that the study has some limitations. More research is needed to better understand how these medications impact brain health.

Reference:

1. Antidepressant use and cognitive decline in patients with dementia: a national cohort study - (https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-025-03851-3)

Source-Medindia