Mirtazapine

TUESDAY, Feb. 25, 2025 (HealthDay news) -- Antidepressants are frequently prescribed to people with dementia for symptoms like anxiety, depression, aggressiveness and sleeplessness. But a specific class of antidepressant medications -- selective serotonin reuptake inhibitors (SSRIs) -- actually might speed up brain decline among some dementia patients, a new Swedish study suggests. Heavier doses of certain SSRIs are tied to a higher risk for severe dementia, researchers reported in a new study published Feb. 24 in the journal BMC Medicine . Taking more than the average amount typically prescribed for these drugs was linked to an additional decline of 0.42 points per year in a dementia scale that runs from 0 to 30, researchers found. The SSRI drug escitalopram was associated with the fastest cognitive decline, followed by citalopram and sertraline . Mirtazapine , which works in a different way, had less negative impact on brain function, researchers found. “Depressive symptoms can both worsen cognitive decline and impair quality of life, so it is important to treat them,” said senior investigator Sara Garcia Ptacek , an assistant professor of neurology at the Karolinska Institute in Solna, Sweden. “Our results can help doctors and other healthcare professionals choose antidepressants that are better adapted for patients with dementia,” she added in a news release. For the study, researchers tracked the brain health of more than 18,700 patients enlisted in the Swedish Registry for Cognitive/Dementia Disorders between May 2007 and Oct. 2018. The patients’ average age was 78. During an average follow-up of more than four years, about 23% of patients received a new prescription for an antidepressant, researchers said. SSRIs were the most commonly prescribed antidepressant, amounting to 65% of all those prescriptions, the study says. “Higher dispensed doses of SSRIs were associated with higher risk for severe dementia, fractures, and all-cause mortality,” the researchers concluded. “These findings highlight the significance of careful and regular monitoring to assess the risks and benefits of different antidepressants use in patients with dementia.” Faster rates of brain decline were observed among men taking antidepressants compared to women, results also show. However, outside experts warn that caution should be exercised when interpreting these results. “There are some important limitations that should be considered,” Dr. Prasad Nishtala , a reader in life sciences with the University of Bath in the U.K., said in a news release. “One major issue is that the severity of depression in dementia patients wasn't fully accounted for, which has the potential to bias the results,” said Nishtala, who reviewed the findings. “Additionally, there may be a ‘channelling bias,’ meaning that certain antidepressants like citalopram and sertraline might have been more commonly prescribed to patients with severe dementia, which could also bias the results.” He added that the study suggests that SSRIs like citalopram and sertraline might also speed up cognitive decline. "However, it doesn’t explain how or why this happens at a biological level,” Nishtala added. “Because of these limitations, the study's findings should be interpreted with caution and ideally replicated using other real-world data sources.” Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

New research suggests that certain antidepressants can accelerate cognitive decline in people with dementia. At the same time, some drugs appear to be less harmful than others, which can help doctors make better treatment decisions, according to the study. New research suggests that antidepressants can accelerate cognitive decline in people with dementia. At the same time, some drugs appear to be less harmful than others, which can help doctors make better treatment decisions, according to the study published in BMC Medicine. 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. 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. Differences between drugs 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 individualised care," says Sara Garcia Ptacek. The study has been funded by the Swedish Research Council, Region Stockholm, the Swedish Dementia Research Foundation, the Alzheimer's Foundation and New Innovative Roads Call -- a private initiative from the Leif Lundblad family and others. The researchers report no conflicts of interest.