Risk for Adverse Outcomes With Antidepressants in Dementia

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Antidepressant prescription within 6 months of dementia diagnosis was associated with a significant increase in risk of mortality.
Antidepressant prescription within 6 months of dementia diagnosis was associated with a significant increase in risk of mortality.

Antidepressant prescription within 6 months of dementia proved to have a positive association with mortality, according to a recent study published in the Journal of the American Medical Directors Association.

In this retrospective study, researchers from the United Kingdom evaluated 5473 patients with Alzheimer disease from a large mental health and dementia care database for antidepressant prescription within 6 months of dementia diagnosis. They measured patient well-being with the Health of the Nation Outcome Scales (HoNOS65+) instrument to evaluate depression severity and other health factors.

A total of 22.8% patients with Alzheimer disease were prescribed an antidepressant either 6 months before (16.5%) or after (6.3%) being diagnosed with dementia. After a mean follow-up of 3.5 years, 44.1% of the patients with Alzheimer disease died.

After adjusting for such potential confounders as symptom severity, functional status, and physical illness, the researchers found that antidepressant prescription within 6 months of dementia diagnosis was associated with a significant increase in risk of mortality (hazard ratio [HR] 1.22; 95% CI: 1.08-1.37 for prescription prediagnosis; 95% CI: 1.04-1.45 for prescription postdiagnosis).

When patients were stratified by the presence of neuropsychiatric symptoms, the prescription of an antidepressant before diagnosis (fully adjusted HR 1.20; P <.05) and after diagnosis (1.22; P <.10) was still associated with mortality in patients without neuropsychiatric symptoms.

The study authors concluded that "antidepressants should be used cautiously in older people affected by [Alzheimer disease], consistent with a [previous] longitudinal study showing that antidepressants are associated with a higher risk of adverse outcomes, including falls, hyponatremia, cardiovascular, and cerebrovascular conditions."

Reference

Mueller C, Huntley J, Stubbs B, et al. Associations of neuropsychiatric symptoms and antidepressant prescription with survival in Alzheimer's disease [published online August 31, 2017]. J Am Med Dir Assoc. doi:10.1016/j.jamda.2017.07.001

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