5 days Ago By Cara Michelle Miller
Patients with dementia who take antidepressants may face faster cognitive decline, a new Swedish research suggests. Depression is very common among people with this neurodegenerative disease. The two conditions are strongly linked, with depression raising the risk of dementia and vice versa.
Declining cognitive function was assessed using the Mini-Mental State Examination (MMSE), a standard tool for evaluating mental capacity. MMSE screens for dementia and tracks cognitive changes over time by assessing orientation, attention, memory, language, and visuospatial skills. Throughout the study, participants filled nearly 12,000 antidepressant prescriptions.
SSRIs—medications that boost levels of the “feel good” hormone serotonin were the most commonly prescribed, making up nearly 65 percent of total prescriptions. Higher doses of antidepressants, particularly SSRIs, were associated with a faster rate of cognitive decline. This pattern held across patient subgroups, including those with Alzheimer’s disease, mixed dementia, and people without a history of depression, suggesting the correlation was not limited to specific profiles.
Some antidepressants had a stronger effect on cognitive decline. Escitalopram (Lexapro) caused the fastest decline, followed by sertraline (Zoloft) and citalopram (Celexa). Mirtazapine (Remeron) also led to cognitive decline but at a slower rate.
Mirtazapine works differently from SSRIs like escitalopram, sertraline, and citalopram. While SSRIs increase serotonin, the brain’s mood-regulating chemical, by preventing its reabsorption, mirtazapine boosts both serotonin and norepinephrine—a neurotransmitter that affects alertness and energy—through a different process. “Our study cannot distinguish whether these findings are due to the antidepressants or the underlying psychiatric indication,” the authors wrote.
Although antidepressant use was linked to faster mental deterioration, the changes were not clinically significant, according to the study. Patients taking SSRIs lost 0.25 to 0.
76 points per year on their mental state examination scores. However, score reductions of less than one are considered clinically insignificant, meaning that the decline was not severe enough to immediately affect daily activities or independence. Antidepressants may not work as effectively in patients with dementia, “possibly because ‘depression in dementia is a different illness’ than depression in people with intact cognition,” the study authors suggested.
The causes of depression in dementia are complex. For some, the challenges of living with dementia—such as the loss of independence—can trigger feelings of sadness or despair. For others, brain damage caused by the disease may directly affect areas involved in regulating mood, contributing to depressive symptoms.
Depression can develop early in dementia or emerge later as the disease progresses, which can be both a symptom and a potential risk factor for the condition. This complicates the relationship, as many symptoms of dementia—such as memory issues and concentration difficulties—overlap with those of depression, making diagnosis challenging. Talk and listen: Encourage open conversations, offering a listening ear instead of practical advice.
If needed, consider counseling or therapy. Social interaction: Reduce isolation with one-on-one interactions, like playing games or holding hands. Stay active: Regular physical activity, such as walking or tai chi, can boost mood and sleep.
Encourage outdoor time in nature. Engage in enjoyable activities: Attending faith services or creative activities like scrapbooking and singing can be fulfilling. Eat well: A balanced diet supports mental health.
Avoid excessive alcohol or caffeine, and enjoy meals with family or friends. Create positive routines: A regular schedule of enjoyable activities lifts mood. Involve the person in daily tasks to boost engagement.
Reduce stress: Adjust the living environment by reducing clutter or improving lighting to create a calmer atmosphere..
