Antidepressants in Dementia - Less Benefit, More Side Effects
With more than 35 million people affected worldwide, the global burden that dementia imposes amounts to 1% of global gross domestic product every year. Dementia has a devastating effect on those affected and their families. Depression is one of the commonest conditions associated with dementia - 20% of people with dementia suffer depression. The class of drugs called antidepressants is widely prescribed for the ailment. The fact that this treatment is not proven scientifically is a source of great distress.
The efficacy and safety of two of the most commonly prescribed antidepressants namely sertraline and mirtazapine in dementia patients were assessed in a recent study in England. 326 elderly patients were involved in the programme. The results were negative and the study stresses on second thoughts before prescribing antidepressants for depression in dementia.
Treatment with these drugs was found to be no better than placebo. The side effects add to the dilemma. While sertraline was notorious for causing nausea, drowsiness and sedation were the most common side effects produced by mirtazapine.
The research suggests that clinicians should reconsider the use of these agents in dementia. Even three months of drug usage did not bring any significant reduction in depression. A number of treatment-associated adverse events were reported instead.
The current study which is perhaps the largest trial of its kind is not devoid of flaws, but it is claimed to the most reliable one till date.
Reference: Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial; Sube Banerjee et al; The Lancet 2011.