Do Antidepressants Contribute to the Risk for Dementia?

Summary and Comment |
April 20, 2017

Do Antidepressants Contribute to the Risk for Dementia?

  1. Joel Yager, MD

In a large Taiwanese registry study, antidepressants taken for any reason were variably associated with increased dementia risk.

  1. Joel Yager, MD

Depression has been associated with increased risk for dementia. Now, researchers have used the Taiwanese national health registry to examine whether antidepressant medications, independent of depression and other conditions linked to subsequent dementia, might contribute to dementia risk.

The investigators identified 5819 individuals who received antidepressant prescriptions for any reason between 2003 and 2006 on at least two occasions more than 30 days apart. Of this group, 17% were diagnosed with depression (major depression, dysthymic disorder, or depressive disorder not otherwise specified), 24% with an anxiety disorder, and 20% with insomnia; many others had assorted medical conditions considered risk factors for dementia. A comparison cohort consisted of 23,276 age- and sex-matched individuals not taking antidepressants. Records were examined through 2011 for subsequent diagnoses of dementia or Alzheimer disease.

Antidepressant use was associated with dementia risk, independent of demographics, stroke, depression, diabetes, hypertension, hyperlipidemia, insomnia, anxiety, cumulative daily dose of antidepressants, and comorbidities. Risks differed by antidepressant class (hazard ratios: selective serotonin reuptake inhibitors [n=6], 3.7; serotonin-norepinephrine reuptake inhibitor [n=1], 4.7; tricyclic antidepressants [n=3], 3.3; tetracyclic antidepressant [n=1], 6.6; monoamine oxidase inhibitor [n=1], 4.9; serotonin antagonist and reuptake inhibitor [n=1], 4.5) and were elevated with highest daily doses measured cumulatively.

Comment

This study lacks data on smoking, concurrent benzodiazepines, and other factors that might correlate with both antidepressant use and dementia risk. Although some studies have suggested that antidepressants spare cognitive function and offer protection against dementia, others have raised concerns similar to the present authors'. A recent systematic review and meta-analysis also found a heightened risk, notably in individuals whose antidepressant use occurred before age 65 (Depress Anxiety 2017; 34:217). While appreciating antidepressants' considerable benefits (as well as the considerable risks of untreated depression), we must undertake the important task of clarifying their long-term risks.

Editor Disclosures at Time of Publication

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders Review (Editor-in-Chief Emeritus); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry

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