Highlights
- •This study examined the association between antidepressant use and the risk of dementia.
- •The group exposed to antidepressants had an increased incidence of dementia.
- •Clinicians, caregivers, and patients may wish to consider this potential negative consequence of antidepressant exposure and aim to balance the costs and benefits of treatment.
Abstract
Objective
To test competing hypotheses that monotherapeutic antidepressant exposure is associated
with an increased versus a decreased risk of dementia.
Methods
A prospective national matched cohort study from Israel (N = 71,515) without dementia
(2002–2012) aged 60 and over were followed up for incident dementia from May 2013
to October 2017. Exposure to antidepressant monotherapy was classified with Anatomical
Therapeutic Chemical Codes (N06A) from January 1, 2013 to December 31, 2016. The association
between antidepressant monotherapy and the risk of incident dementia was quantified
with hazard ratios (HR) and their 95% confidence intervals (CI) obtained from Cox
regression models unadjusted and adjusted for 42 covariates. The robustness of the
results was tested with 24 sensitivity analyses: 19 analyses restricted to subsamples
with plausible differential dementia risks (e.g., anxiety and depression), and 5 analyses
across and within antidepressant drug classes.
Results
In the primary analysis, the risk of incident dementia for the group exposed to antidepressant
monotherapy compared to the group unexposed to antidepressants was estimated with
an unadjusted HR = 4.09 (df = 1, 95% Wald CI = 3.64, 4.60) and an adjusted HR = 3.43
(df = 1, 95% Wald CI = 3.04, 3.88). Across the 24 sensitivity analyses the estimated
adjusted HR values ranged from 1.99 to 5.47.
Conclusion
In this study, monotherapeutic antidepressant exposure in old age was associated with
increased incident dementia. Clinicians, caregivers, and patients may wish to consider
this potentially negative consequence of antidepressant exposure and aim to balance
the costs and benefits of treatment.
Key Words
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Article info
Publication history
Published online: May 28, 2019
Accepted:
May 27,
2019
Received in revised form:
May 27,
2019
Received:
March 5,
2019
Footnotes
Previous Presentation: None.
Identification
Copyright
© 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
