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Antidepressant Use Among US Nursing Home Residents With Dementia
Shiwei Liang1, Kate L Lapane1, Brian R Ott2
1Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Journal of the American Geriatrics Society
|May 6, 2026
Summary
Antidepressant use is common in nursing home residents with Alzheimer's disease and related dementias (ADRD), often prescribed even without documented depression. This highlights potential overuse and the need for better symptom assessment in this population.
Area of Science:
- Geriatric Medicine
- Psychopharmacology
- Neurodegenerative Diseases
Background:
- Alzheimer's disease and related dementias (ADRD) affect millions, with nursing homes as primary care sites.
- Antidepressants are frequently prescribed to nursing home residents with ADRD, but prescribing patterns require further investigation.
Purpose of the Study:
- To analyze antidepressant prescribing patterns in long-stay nursing home residents with ADRD.
- To compare antidepressant use based on potential indications like depression, anxiety, pain, and insomnia.
- To identify resident and facility characteristics associated with antidepressant use.
Main Methods:
- Cross-sectional study using 2018 Minimum Data Set 3.0 assessments linked to Medicare claims.
- Included long-stay nursing home residents aged ≥65 years with ADRD.
- Described antidepressant usage by drug class and type, comparing users and non-users.
Main Results:
- Over half (51.6%) of residents with ADRD used antidepressants, with use highest for depression, anxiety, pain, and insomnia.
- 14.1% of residents without these conditions still received antidepressants.
- Selective serotonin reuptake inhibitors (SSRIs) were the most common class; polypharmacy increased use, while certain comorbidities decreased it.
Conclusions:
- Antidepressants are frequently prescribed to nursing home residents with ADRD, often without clear documentation of depressive symptoms.
- Cognitive impairment and reliance on staff observation may contribute to prescribing discrepancies.
- Further research is needed to assess treatment appropriateness, deprescribing, and the risks/benefits of long-term antidepressant use in this population.
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