Antidepressant medications may not be more effective than placebos in the treatment of depression in older adults who also have dementia, and the risks of antidepressant treatment may outweigh the benefits, particularly if the depression is not severe, according to two studies published this year.

Between 20 percent and 40 percent of people with dementia experience a diagnosable depressive disorder, nearly half major depression. This condition not only can be painful, it also increases risks of physical illness, disability and premature mortality. (3) In addition, it often results in decline in cognitive and functional capacity over and above the decline that results from dementia alone. Depression appears to have a particularly negative impact on "instrumental activities of daily living," including preparing meals, housework, managing finances, shopping, caring for others, etc.

Clearly, overcoming depression is important for people with dementia. But, recent studies have failed to demonstrate that antidepressants improve depression more than the attention received by participating in a research study.

One study, done with the support of the British National Health Service to evaluate the standard approach to treating depression in people with dementia, showed no benefit of antidepressants compared to placebos but did show more adverse side-effects. For this reason the authors strongly recommend a change in the standard treatment approach. Instead of starting with an antidepressant, they suggest that the first step should be "watchful waiting" while helping people with dementia and their caregivers to cope better with the difficulties typical of living with dementia. They suggest that many depressive episodes in dementia patients may resolve on their own. If not, psychotherapy provided by a specialist may help. The authors maintain that antidepressants should be reserved for depression that is severe or persistent.

Continue reading.

Labels: antidepressants, antipsychotics, dementia, Depression, placebos