If You Take One Of These Drugs
It’s always good to review the potential benefits and harms of these medications with your doctor. If a drug appears problematic, the two of you can explore alternatives by considering the reason it was prescribed and seeing if there is a different type of drug that can be used as a replacement.
Don’t stop taking the drugs on your own. It isn’t safe to quit most benzodiazepines and anticholinergic drugs “cold turkey.” Work with your clinician to develop a plan for tapering off them.
What Are The Implications
This updated Cochrane review supports the advice that antidepressants should not be prescribed to treat depression in people living with dementia.
The previous version only included four studies, with a total of 137 participants. The additional six trials, with more participants, have strengthened the message and confidence in the finding. As the largest systematic review to date, it supports NICE guidance.
There wasnt enough evidence to draw conclusions about any individual antidepressant, or about different types of dementia. There was also little evidence about the longer-term effects of antidepressants. Future research could focus on these areas to address any doubts about the applicability of this finding.
What Did It Find
- There was little or no difference in depression scores between the antidepressant and placebo groups after 6 to 13 weeks .
- According to the Cornell Scale for Depression in Dementia , there was also no difference between groups after six to nine months .
- More people taking antidepressants recovered from depression by 6 to 13 weeks . However, only one trial continued to 24 weeks, and so it is unclear whether antidepressants have an effect on long-term remission.
- Antidepressants had no effect on peoples ability to carry out daily living tasks at 6 to 13 weeks .
- People taking antidepressants were more likely to suffer at least one adverse event than those on placebo treatment .
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Can Long Term Antidepressant Use Lead To Memory Loss And Brain Damage
Taking prescription medication to help level out your own mental state is a must for some people and should certainly not be looked down on. Prescription medication has the ability to help level out chemicals in the brain to help treat depression and other mental ailments that you might be dealing with. Most antidepressants have been studied tremendously to ensure that they are safe for long term human consumption, but some might not be so safe. If you believe that antidepressants have caused memory loss, take the time to talk to a brain injury law firm to see what can be done.
Drugs For Treating Sleep Disturbance
Sleep disturbance, and in particular persistent wakefulness and night-time restlessness, can be distressing for the person with dementia and disturbing for carers. Many of the drugs commonly prescribed for people with dementia can cause excessive sedation during the day, leading to an inability to sleep at night. Increased stimulation and activity during the day can reduce the need for sleep-inducing medications at night. Hypnotics are generally more helpful in getting people off to sleep at bedtime than they are at keeping people asleep throughout the whole of the night. They are usually taken 30 minutes to one hour before going to bed.
Side-effects
If excessive sedation is given at bedtime, the person may be unable to wake to go to the toilet and incontinence may occur, sometimes for the first time. If the person does wake up during the night despite sedation, increased confusion and unsteadiness may occur.
Hypnotics are often best used intermittently, rather than regularly, when the carer and person with dementia feel that a good nights sleep is necessary for either or both of them. The use of such drugs should be regularly reviewed by the doctor.
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Why Do Some Older Adults Treated With Antidepressants Progress To Dementia
See related article by Bartels et al
Why Do Some Older Adults Treated With Antidepressants Progress to Dementia?
The relationship between a history of depression and incident dementia is well established, yet incompletely understood. A history of remote or recent depression is associated with about a 2-fold higher risk of incident dementia.1 Despite large studies designed to elucidate the mechanism underlying this epidemiologic relationship, it is still not clear whether depression is a causal contributor to dementia, a disorder with common risk factors, or a symptom of an underlying neurodegenerative process and a prodrome of dementia.2-4 This uncertainty is due in large part to the complexity of these two clinical syndromes, each with heterogeneous etiologies, pathophysiologies, and treatments, all of which can interact with biopsychosocial factors across individuals and populations. Thus, a given individual with depression may progress from depression to dementia due to one, all, or none of the above mechanisms.
Regardless, the lower odds of dementia associated with longer-term use of 17 of 18 antidepressant treatments studied are evidence against a harmful effect of antidepressants on dementia. These associations also suggest that unadjusted confounds are contributing to the results: we would not expect to observe associations in opposite directions depending on duration, as was observed with escitalopram.
Funding/support: None.
REFERENCES
Conflict Of Interest Statement
Anonymized data were provided by the AOK Niedersachsen. JW is supported by an Ilídio Pinho professorship and iBiMED , at the University of Alveiro, Portugal. JW received honoraria for consulting activities, lectures or advisory board participation from Pfizer, Eli Lilly, Hoffmann-La-Roche, MSD Sharp + Dome, Janssen-Cilag GmbH, Immungenetics AG, Boehringer Ingelheim. CW-M cooperates with LivaNova GmbH, Janssen-Cilag GmbH, Servier GmbH, Vitos Clinics, Privatinstitut für Klinikmanagement, University of Heidelberg, Deutsches Krankenhausinstitut, Deutsche Krankenhausgesellschaft. PH was financially supported by a scholarship from the Research School for Translational Medicine at the University Medical Center in Goettingen , which was funded by the Lower Saxony Ministry of Science and Culture .
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Confirmed: Antidepressants And Other Drugs Cause Dementia
05/29/2018 / By Tracey Watson
The largest and most detailed study of its kind has just confirmed that a group of chemical drugs known as anticholinergics, which include antidepressants, antispasmodics, Parkinsons drugs and bladder control medications, among others, may be directly linked to the development of dementia.
The study, which was conducted by researchers from the University of East Anglia in the United Kingdom, found that long-term use of these drugs is strongly linked to the onset of dementia, sometimes many years later.
Depression As A Risk Factor
It is well established that depression is a risk factor for dementia, but speculation still exists that the cognitive dysfunction occurring with depression leads to the decline and impairment recognized as dementia. More research has been done to establish what type of depression predicts the development of dementia results show that early-onset or late-onset , are the most likely to lead to dementia later in life.
A study done in Nature Review Neurology affirmed the correlation between depressive symptoms early in life, and the magnified increase in dementia risk.
For older people already suffering from dementia, depression may manifest itself as physical symptoms, rather than its commonly known cognitive symptoms. These symptoms can include a loss of appetite or energy. This does not discount the many cognitive symptoms that can appear as a result of depression the Alzheimer’s Society provides a comprehensive list of these symptoms on their website.
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What Did The New Study Involve
The research, conducted by Carol Coupland, a professor of medical statistics in primary care at the University of Nottingham in England, and colleagues, evaluated anticholinergic drugs prescribed to nearly 285,000 people age 55 and older. About 59,000 of them had a diagnosis of dementia. The information came from a database of medical records from patients in more than 1,500 general practices in Britain, the authors said.
Researchers looked at the medical records of patients who were diagnosed with dementia and examined the drugs they had been prescribed from 11 years to one year before their diagnosis. They compared their medications during that time frame with those of people who did not have a diagnosis of dementia. They recorded which of 56 anticholinergic medications people were prescribed, and at what dose and how long. They accounted for factors like body mass index, smoking, alcohol consumption, other medical conditions and use of other medications.
The study found a 50 percent increased risk of dementia among people who used a strong anticholinergic drug daily for about three years within that 10-year period. The association was stronger for antidepressants, bladder drugs, antipsychotics and epilepsy medications, the study said. Researchers did not find any increased risk of dementia with antihistamines, bronchodilators, muscle relaxants or medications for stomach spasms or heart arrhythmias.
Could Medications Contribute To Dementia
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
Alzheimers disease and other illnesses that cause dementia are devastating, not only for those affected but also for their friends and family. For most forms of dementia, there is no highly effective treatment. For example, available treatments for Alzheimers disease may slow the deterioration a bit, but they dont reverse the condition. In fact, for most people taking medications for dementia, it may be difficult to know if the treatment is working at all.
Experts predict that dementia will become much more common in the coming years. We badly need a better understanding of the cause of these conditions, as this could lead to better treatments and even preventive measures.
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Why These Drugs Have A Stronger Effect In Older People
As we age, our ability to process medication changes. The kidneys and liver clear drugs more slowly, so drug levels in the blood remain higher for a longer time. People also gain fat and lose muscle mass over time. Both these changes affect the way drugs are distributed to and broken down in body tissues. And because these drugs are stored in body fat, they can continue to produce effects days after people stop taking them, especially in people with a higher proportion of body fat. In addition, older people tend to take more prescription and over-the-counter medications, each of which has the potential to suppress or enhance the effects of the others.
Risks Should Be Carefully Considered
To assess the strength of anticholinergic drugs and how often the participants took them, the team looked at available information about prescriptions over a period of 10 years.
However, they note that this is an observational study, so they cannot confirm whether the drugs are directly responsible for the increased risk of dementia.
The researchers add that doctors may have prescribed some of these drugs to their patients precisely for the treatment of very early dementia symptoms.
Nevertheless, Prof. Coupland argues that the study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinsons drugs, and epilepsy drugs.
The risks of this type of medication should be carefully considered by healthcare professionals alongside the benefits when the drugs are prescribed and alternative treatments should be considered where possible.
Prof. Carol Coupland
These findings also highlight the importance of carrying out regular medication reviews.
We found a greater risk for people diagnosed with dementia before the age of 80, which indicates that anticholinergic drugs should be prescribed with caution in middle-aged people as well as in older people, she concludes.
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Assessment Of Cognitive Function
At each HRS wave, cognitive function was assessed using a previously described and validated 27-point scale based on a battery of tests that included tests of memory, serial 7 subtractions, and naming. This battery is a subset of an expanded battery administered to participants aged â¥65 years in the HRS the expanded battery includes measures of orientation.24 Participants requiring proxy interviews were excluded from this analysis. Cut points for cognitive function were based on prior studies with the HRS data,25, 26 as well as methods used for the Aging, Demographics, and Memory Study, a supplemental study of dementia in the HRS.27 These cut points defined a level of cognitive function that was generally consistent with normal function , cognitive impairment but no dementia , and dementia .28
Cholinesterase Inhibitors And Other Drugs
The new generation of cholinesterase inhibitor drugs were originally developed to improve memory and the ability to carry out day-to-day living activities in people with Alzheimers disease.
Evidence suggests that these drugs also have slight beneficial effects on behavioural symptoms, particularly apathy , mood and confidence, delusions and hallucinations. Taking cholinesterase inhibitor drugs may therefore reduce the need for other forms of medication. However, in higher doses these cholinesterase inhibitor drugs may occasionally increase agitation and produce insomnia with nightmares.
Memantine is the most recent antidementia drug to be developed. It works in a different way to the anticholinesterase drugs and is the first drug approved for those in the middle to later stages of Alzheimers disease.
There is some evidence that memantine has a positive effect on mood, behaviour and agitation.
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Drugs For Treating Depression
Symptoms of depression are extremely common in dementia. In the early stages they are usually a reaction to the persons awareness of their diagnosis. In the later stages of the illness, depression may also be the result of reduced chemical transmitter function in the brain. Simple non-drug interventions, such as an activity or exercise programme, can be very helpful. In addition, both types of depression can be treated with antidepressants, but care must be taken to ensure that this is done with the minimum of side-effects.
Antidepressants may be helpful not only in improving persistently low mood but also in controlling the irritability and rapid mood swings that often occur in dementia and following a stroke. Once started, the doctor will usually recommend prescribing antidepressant drugs for a period of at least six months. In order for them to be effective, it is important that they are taken regularly without missing any doses. Improvement in mood typically takes two to three weeks or more to occur, whereas side-effects may appear within a few days of starting treatment.
Side-effects
Newer antidepressants are preferable as first line treatments for depression in dementia. Drugs such as fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram and escitalopram do not have the side-effects of tricyclics and are well tolerated by older people.
Practical Tips On Medications To Manage Difficult Behaviors In Dementia
You may be now wondering just how doctors are supposed to manage medications for difficult dementia behaviors.
Here are the key points that I usually share with families:
- Before resorting to medication: its essential to try to identify what is triggering/worsening the behavior, and its important to try non-drug approaches, including exercise.
- Be sure to consider treating possible pain or constipation, as these are easily overlooked in people with dementia. Geriatricians often try scheduling acetaminophen 2-3 times daily, since people with dementia may not be able to articulate their pain. We also titrate laxatives to aim for a soft bowel movement every 1-2 days.
- No type of medication has been clinically shown to improve behavior for most people with dementia. If you try medication for this purpose, you should be prepared to do some trial-and-error, and its essential to carefully monitor how well the medication is working and what side-effects may be happening.
- Antipsychotics and benzodiazepines work fairly quickly, but most of the time they are working through sedation and chemical restraint. They tend to cloud thinking further. It is important to use the lowest possible dose of these medications.
- Antidepressants take a while to work, but are generally well-tolerated. Geriatricians often try escitalopram or citalopram in people with dementia.
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Antidepressants And Amyloid In Human Studies
Data from human studies suggest that serotonin signaling is associated with less A accumulation. In a retrospective study antidepressant-treated cognitively normal elderly participants had significantly less amyloid load as quantified by PET imaging with PIB compared to participants who were not exposed to antidepressants within the past 5 years. Cumulative time of antidepressant use within the 5-year period preceding the scan correlated with less plaque load. In a prospective study in healthy human volunteers, the effects of citalopram on A production and A concentrations in CSF were measured with CSF sampling during acute dosing of citalopram. A production in CSF was slowed in the citalopram group compared to placebo and the change was associated with an almost 40% decrease in total CSF A concentrations in the antidepressant-treated group.
These results suggest that inhibition of A oligomer-mediated aggregation significantly contributes to the overall neuroprotective activity of antidepressants. The ability to decrease A concentrations by antidepressant treatment is an important potential strategy for AD and might be a key target for future AD prevention.
Antidepressants Linked To Dementia Including Alzheimers
New Canadian research finds antidepressants may be contributing to Alzheimers and other dementias.
According to the University of Regina research, popular SSRI antidepressant medications, such as Prozac, Paxil, Lexapro, Zoloft, etc., are associated with a twofold increase in the odds of developing some form of cognitive impairment, such as dementia, including Alzheimers.
This association was even stronger for people who took antidepressants before the age of 65.
The study doesnt prove cause and effect. However, the link is significant and needs to be carefully evaluated in consideration of how often these medications are prescribed, from ordinary cases of sadness to insomnia, pain, and hot flashes. They are even becoming popular drugs for children.
Theyre being prescribed off label, meaning for non-depression related situations. Theyre being prescribed to very young children and to the very old, said Dr. Darrell Mousseau, a professor in the department of psychiatry at the University of Saskatchewan and the studys senior author.
Theyre almost becoming the antibiotic of this century: If youve got a disease, take an SSRI. Its going to help you in one way, shape or form.
The study involved looking at a total of nearly 1.5 million people who were pooled from five studies. The findings showed that people with dementia were twice as likely to have been exposed to an antidepressant compared with people without dementia.
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