Antidepressants for treating depression in dementia.

Area of Science:

• Neuroscience
• Clinical Pharmacology
• Geriatrics

Background:

• Widespread use of antidepressants for dementia with depressive symptoms.
• Uncertainty regarding clinical efficacy of these treatments.
• This review is an update of a 2002 publication.

Purpose of the Study:

• To determine the efficacy and safety of antidepressants for dementia patients with depression.
• To evaluate any type of antidepressant against placebo.
• To use recognized criteria for diagnosing dementia and depression.

Main Methods:

• Systematic review and meta-analysis of double-blind, randomized trials.
• Searched ALOIS (Cochrane Dementia and Cognitive Improvement Group's Register) up to August 2017.
• Assessed risk of bias and used GRADE methods for evidence quality.

Main Results:

• High-quality evidence shows little/no difference in depression scores between antidepressants and placebo at 6-13 weeks (SMD -0.10).
• Moderate-quality evidence suggests little/no difference in depression scores at 6-9 months (MD 0.59).
• Antidepressants may increase adverse events (OR 1.55) and dropout rates (OR 1.51) compared to placebo.

Conclusions:

• Variable quality evidence does not strongly support antidepressant efficacy for depression in dementia beyond 12 weeks.
• Little to no effect observed on depression rating scales (high-quality evidence).
• Antidepressant treatment may lead to more adverse events; insufficient evidence for specific drug or dementia subtypes.