Study: antidepressants and dementia: more risk than benefits?

Reference

Banerjee S., Hellier J., Dewey M. et al. Sertraline or Mirtazapine against depression in dementia (HTA-SADD): a randomized, multicenter, double-blind, placebo-controlled study. lanzette. 2011; 378 (9789): 403-411.

Design

A parallel, double-blind, placebo-controlled study on the assessment of health technology on the use of antidepressants in depression in dementia (HTA-SADD) with participants from age psychiatric services in 9 centers in England.

participant

The participants were made available to the participants in 9 centers in England. Participants were eligible to participate if they had a probable or possible Alzheimer's disease, depression (duration ≥ 4 weeks) and a CSDD value (Cornell scale for depression in Dementia) of 8 or more. Participants were not entitled to participate if they were clinically critical (e.g. suicide risk), for studying medication, antidepressants income, took part in another study or had no supervisor.

study medication and dosage

sertralin (target dose 150 mg per day), Mirtazapin (45 mg) or placebo

target parameter

The primary endpoint was the reduction in depression (CSDD score) after 13 weeks (the results up to 39 weeks were also evaluated), evaluated with a mixed linear regression model, adapted to CSDD output value, time and treatment center.

most important knowledge

The decline in depression after 13 weeks does not differ between 111 control persons and 107 participants who received sertralin (mean difference 1,17; 95 % -KI: -0.23–2.58; p = 0.10) or Mirtazapin (0.01; 95 % KI: -1,37–1,38; p = 0.99) or between participants of the Mirtazapin and Sertralin group (1.16; 95 %-KI: -0.25–2.57; p = 0.11); These findings lasted up to 39 weeks. Fewer controls had side effects (29 out of 111). [26%]) as the participants of the Sertralin group (46 of 107). [43%]; p = 0.010) or Mirtazapin group (44 of 108). [41%]; p = 0.031) and less serious undesirable events that were classified as serious (control group) ( p = 0.003). Five patients in each group died in week 39.

effects on practice

antidepressants did not lead to an improvement in the results compared to placebo; However, they increased the risk of unwanted events. Therefore, the current practice should be used to use antidepressants with the usual care as an initial treatment of depression in Alzheimer's disease. In this study, “common care” included the transfer to psychiatric care in old age.

Comment

The study says: "Despite these results, the current practice is to use antidepressants, often sertraline, as an initial treatment for depression in dementia." What were the findings? When searching in the literature, which in their opinion was "sparse and ambiguous", the authors of article found six relevant studies (systematic overviews from the PubMed and Cochrane Library databases) for the treatment of depression in people with dementia, only three meta -analyzed. A study had balanced results (with the tricyclic antidepressant clomipramine in 24 people). 1 The second was negative (using the tricyclic antidepressant imipramin in 61 people) 2 and the third party (using the selective serotonin reuptake in Sertralin at 44 People). ^{3 The review came to the conclusion that there was only weak evidence of the effectiveness of antidepressants in dementia. The tricyclic are medication that are not used often in the population (depression in dementia) and the anticholinergic side effects. In another relevant randomized study, 67 people who were administered in Sertral were examined compared to 64 people to whom a placebo was administered.}

Despite the results of these studies, antidepressants, often sertraline, are used in the current practice as initial treatment for depression in dementia. Since the authors of the current study knew how serious and challenging a problem for public health, and that depression often occurs in dementia, they wanted to find out whether this sub -group of depressive patients would be better supplied with antidepressants. And after 13 weeks of the study, they found that the greatest absolute improvement occurred under placebo.

"Due to the lack of use compared to placebo and the increased risk of undesirable events, the current practice of using this antidepressant should be covered with the usual care for the first line treatment of depression in Alzheimer's disease," concluded the authors.

The supervisors of these patients with depressive dementia perform better in terms of quality of life and mental health if their relatives received a placebo.

antidepressants as a drug category have proven side effects such as increased suicidal thoughts and possibly serious mood swings. Since mood swings are also in the foreground in dementia patients, the application of such a means of dementia patients is problematic from the outset. In addition, many of our older people take several prescription drugs, and antidepressants have a long list of interactions between medication. Unfortunately, dementia patients may not be able to communicate new or changing symptoms appropriately due to these interactions.

Interestingly, the supervisors of these depressive dementia patients performed better with quality of life and mental health if their relatives received a placebo instead of sertraline. The supervisors of the participants of the Mirtazapin Group also had higher quality of life than those of the Sertralin group, at least after 13 weeks.

And who overall best cut off? Remember that "normal care" in this study included the transfer to age psychiatric services. The depressive dementia patients who were transferred to age psychiatric services showed a strong, consistent pattern of improvement in depression after 13 and 30 weeks. Maybe our elders just need someone who spends time with them, and not another pill to throw in. Perhaps our dependence on technology has overwhelmed our reason and our common sense. If we spend time with conversations and actually lived with our older ones, they might not get dementia at all. If we focused on real prevention - eating real foods, drinking clean water, doing sports in a way that we enjoy, maintaining healthy relationships, keeping the mind actively, maintaining supporting social structures - we might all have a better chance of getting old without disease affecting our wisdom in old age