Harmful effects of ceasing antidepressants in dementia
People with dementia who stop taking antidepressants can experience a significant increase in depressive symptoms compared to those who continue treatment, a new Dutch study shows, leading Australian experts to question the benefits of prescribing the drugs in the first place.
The first randomised controlled trial of antidepressant discontinuation in patients with dementia and neuropsychiatric symptoms reported that the 68 study patients who discontinued SSRIs fared worse on depression and neuropsychiatric testing than the 68 patients who continued SSRI therapy.
Reporting in the BMJ, the study found “significantly more patients worsened in the discontinuation group than in the continuation group,” contrary to the Dutch researchers’ hypothesis that discontinuing treatment would not change a patient’s depressive symptoms.
“A worsening of depressive symptoms after discontinuation could indicate that antidepressants are effective in patients with dementia and neuropsychiatric symptoms,” they said.
But earlier, experts had argued that with little evidence in favour of using antidepressants to treat patients with dementia it was becoming increasingly difficult to justify their widespread use in nursing homes.
Professor David Le Couteur, President of the Australasian Society for Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) told Psychiatry Update the study raised concerns over the use of antidepressants in patients with no history of depression.
“Antidepressants should not be used to control behaviour in people with dementia”, yet “[the study cohort] and half of Swedish nursing home patients with dementia are on antidepressants, suggesting they … are not only used to treat depression but most likely to modify behaviour,” he told Psychiatry Update.
The study concluded antidepressants could still be discontinued in most patients considering 86% of patients who ceased SSRIs tolerated the discontinuation, but noted “these patients should be monitored carefully to identify those with worsening depressive symptoms.”Professor Le Couteur agreed"
“What this study shows is that there’s less than one in 15 patients who might benefit from continuing antidepressant therapy”, which suggests “it’s possible to discontinue antidepressants if there’s a problem,” he said.
Original article is
Bergh, et al. (2012). Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial
BMJ 2012;344:e1566 BMJ
Click on the following link to access the full BMJ article (should work on most computers):