COMMENTARY

New Data on Treating Depression in Dementia

Peter M. Yellowlees, MBBS, MD

Disclosures

February 13, 2019

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

The use of antidepressants in patients with dementia and depressive symptoms is widespread, but clinical efficacy is uncertain. Now a team of investigatorsfrom the University of Cambridge, England, have performed a review[1] of the Cochrane Dementia and Cognitive Improvement Group's Specialised Register of trials and grey literature sources to determine the efficacy and safety of any type of antidepressant for patients who have been diagnosed with dementia and depression.

The researchers found 10 studies comprising 1592 patients, and concluded that the available evidence is of variable quality and does not provide strong support for the efficacy of antidepressants for treating depression in patients with dementia, especially beyond 12 weeks. Moderate-quality evidence suggested improved remission rates with antidepressants. There was some evidence that antidepressant treatment may cause adverse events.

Where does this leave us? We have a common clinical problem of depression associated with dementia but little evidence from clinical trials of the treatment efficacy of antidepressants, the historical mainstay intervention. Most clinicians who are experienced in treating this group of patients will continue using antidepressants because we have strong anecdotal evidence of their effectiveness in some patients, especially in people with pseudodementia, where cognitive impairment may present as a depressive equivalent symptom. So while our clinical practice is unlikely to be changed by this review, it is clear that we need more definitive clinical trials to give us the evidence we need to help our patients.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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