Potentially inappropriate medication: Association between the use of antidepressant drugs and the subsequent risk for dementia

• Published in: Journal of affective disorders 2018-01, Vol.226, p.28-35
• Main Authors: Heser, Kathrin, Luck, Tobias, Röhr, Susanne, Wiese, Birgitt, Kaduszkiewicz, Hanna, Oey, Anke, Bickel, Horst, Mösch, Edelgard, Weyerer, Siegfried, Werle, Jochen, Brettschneider, Christian, König, Hans-Helmut, Fuchs, Angela, Pentzek, Michael, van den Bussche, Hendrik, Scherer, Martin, Maier, Wolfgang, Riedel-Heller, Steffi G., Wagner, Michael
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antidepressant drugs; Antidepressants; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Cognition; Dementia; Dementia - chemically induced; Dementia - diagnosis; Depression - drug therapy; Female; Humans; Late-life depression; Male; Oldest-old; Potentially inappropriate medication; Potentially Inappropriate Medication List; Primary Health Care - methods; Proportional Hazards Models; Prospective Studies; Risk Factors
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2017.09.016

Potentially inappropriate medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia. We used data of a prospective cohort study of non-demented primary care patients (n = 3239, mean age = 79.62) to compute Cox proportional hazards models. The risk for subsequent dementia was estimated over eight follow-ups up to 12 years depending on antidepressant intake and covariates. The intake of antidepressants was associated with an increased risk for subsequent dementia (HR = 1.53, 95% CI: 1.16–2.02, p = .003; age-, sex-, education-adjusted). PIM antidepressants (HR = 1.49, 95% CI: 1.06–2.10, p = .021), but not other antidepressants (HR = 1.04, 95% CI: 0.66–1.66, p = .863), were associated with an increased risk for subsequent dementia (in age-, sex-, education-, and depressive symptoms adjusted models). Significant associations disappeared after global cognition at baseline was controlled for. Methodological limitations such as selection biases and self-reported drug assessments might have influenced the results. Only antidepressants considered as PIM were associated with an increased subsequent dementia risk. Anticholinergic effects might explain this relationship. The association disappeared after the statistical control for global cognition at baseline. Nonetheless, physicians should avoid the prescription of PIM antidepressants in elderly patients whenever possible. •Potentially inappropriate antidepressants were associated with an increased subsequent dementia risk.•Other antidepressants were not associated with an increased subsequent dementia risk.•The association between antidepressants and dementia disappeared after cognition was controlled for.