Are Antidepressants Worsening Cognitive Decline in Dementia?

Some antidepressants may do more harm than good. New research links them to faster cognitive decline in dementia patients. Therefore, doctors should prescribe depression pills wisely for better brain health.

Antidepressants may speed up cognitive decline in people with dementia, but some are less harmful than others, helping doctors choose better treatments, according to the study published in BMC Medicine ().

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‘Did You Know?
The SSRI escitalopram, an antidepressant, is linked to the fastest cognitive decline in dementia patients, followed by citalopram and sertraline. #antidepressants #dementia #brainhealth #medindia’

Antidepressants for Anxiety and Depression in Dementia

Antidepressants are often used to relieve symptoms such as anxiety, depression, aggressiveness, and sleep disturbances in dementia sufferers.

However, a new observational study based on data from the Swedish Dementia Registry (SveDem) shows that patients with dementia who are treated with antidepressants experience an increased cognitive decline compared to patients who do not receive this medication.

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The study is based on a comprehensive analysis of registry data from 18,740 patients, of whom approximately 23 percent were treated with antidepressants. During the course of the study, a total of 11,912 prescriptions of antidepressants were registered, with selective serotonin reuptake inhibitors (SSRIs) accounting for 65 percent.

“Depressive symptoms can both worsen cognitive decline and impair quality of life, so it is important to treat them. Our results can help doctors and other healthcare professionals choose antidepressants that are better adapted for patients with dementia,” says Sara Garcia Ptacek, researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and the study's last author.

The researchers from Karolinska Institutet and Sahlgrenska University Hospital in Gothenburg have followed the patients' cognitive development over time and compared both medicated and non-medicated groups as well as different types of antidepressants.

Although it is not currently possible to determine whether the cognitive impairment is due to the drugs or to the depressive symptoms themselves, the researchers were able to see that antidepressants were associated with increased cognitive decline.

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Citalopram, Sertraline and Escitalopram: Which Antidepressants Speed Up Cognitive Decline?

The study also points to differences between different drugs. The SSRI escitalopram was associated with the fastest cognitive decline, followed by the SSRIs citalopram and sertraline.

Mirtazapine, which has a different mechanism of action, had less negative cognitive impact than escitalopram.

The researchers now want to investigate whether certain patient groups, such as people with specific dementia types or biomarkers, respond better or worse to different antidepressants.

“The goal is to find these subgroups to create more individualized care,” says Sara Garcia Ptacek.

Reference:

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-Eurekalert

Quiz on Antidepressants
The use of antidepressants is quite common with an increase in stress-related depression of the modern world. The tricyclic antidepressants like amitriptyline and imipramine are among the older drugs for the treatment of depression. Newer drugs like ...