Antidepressants of questionable value in patients with dementia

  • Dudas R & al.
  • Cochrane Database Syst Rev
  • 31 Aug 2018

  • curated by Jim Kling
  • Clinical Essentials
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Takeaway

  • A review of high-quality evidence shows that antidepressants to do not improve depressive symptoms in patients with dementia.
  • Moderate-quality evidence suggests some improvement in remission rates, but this would need to be confirmed by further research, according to the authors of a Cochrane review.

Why this matters

  • Antidepressants are frequently prescribed to patients with dementia, who often experience depression.
  • A previous Cochrane review found evidence for the benefit of psychological treatments in this population, but the evidence was of poor quality.

Study design

  • This Cochrane review included 10 double-blind, randomized trials comparing antidepressant vs placebo treatment in patients with dementia and depression (n=1592).
  • Funding: National Institute for Health Research; Collaborations for Leadership in Applied Health Research and Care.

Key results

  • Antidepressant vs placebo treatment showed little or no difference in:
    • depression endpoint mean scores at 6-13 weeks: standardized mean difference, −0.10 (95% CI, −0.26 to 0.06; n=614; 8 studies; high quality-evidence); or
    • Cornell Scale for Depression in Dementia at 6-9 months: mean difference, 0.59 (95% CI, −1.12 to 2.3; n=357; 2 studies; moderate-quality evidence).
  • Antidepressant vs placebo treatment showed a higher remission rate at 6-12 weeks (OR, 2.57; 95% CI, 1.44-4.59; n=240; 4 studies; moderate-quality evidence).

Limitations

  •  Potential biases.

Coauthored with Chitra Ravi, MPharm

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