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Author's copy - International Journal of Geriatric Psychiatry (Farina 2016).pdf (709.03 kB)

What is the therapeutic value of antidepressants in dementia? A narrative review

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posted on 2023-06-21, 06:02 authored by Nicolas Farina, Lucy Morrell, Sube Banerjee
Objectives: Antidepressants are commonly used in dementia. Depression is a frequent and important co-morbidity in dementia and antidepressants are often used to treat depression and more widely. However there are questions about their utility in depression in dementia and other behavioural and psychological symptoms of dementia (BPSD). The aim of this narrative review is to summarise the evidence on whether there is therapeutic value in prescribing antidepressants to people with dementia. Methods: A PubMed search was performed to identify RCTs that prescribed antidepressants to people with dementia, either in the treatment of BPSD (depression, anxiety, agitation/aggression, psychosis, apathy) or for secondary outcomes (quality of life, carer burden, activities of daily living, cognition, clinical severity, adverse events). Results: Thirty-six RCTs were identified (participant n=3,386). A consistent finding in well-designed blinded placebo controlled trials in dementia is the lack of positive effect of antidepressants on outcomes of interest including depression. One large well-designed study has reported a significant reduction in agitation in people with dementia, but at the expense of clinically significant adverse events. Otherwise change observed in open trials is also seen in the placebo group, suggesting any effect is not attributable to the prescription of antidepressants. Conclusions: It is striking how few data there are on indications other than depression. We should question the use of antidepressants in dementia. Definitive trials of clinical effectiveness of specific indications such as anxiety and agitation in dementia and discontinuation of antidepressants in dementia are needed.

History

Publication status

  • Published

File Version

  • Accepted version

Journal

International Journal of Geriatric Psychiatry

ISSN

0885-6230

Publisher

John Wiley & Sons

Issue

1

Volume

32

Page range

32-49

Department affiliated with

  • BSMS Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2017-01-05

First Open Access (FOA) Date

2017-09-05

First Compliant Deposit (FCD) Date

2017-01-05

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