For Alzheimer’s patients, antidepressants no better than placebo
July 19th, 2011
02:12 PM ET

For Alzheimer’s patients, antidepressants no better than placebo

Two antidepressants commonly prescribed to people with dementia appear to be no better than a sugar pill at easing the symptoms of depression in Alzheimer’s patients, according to a new study published today in the Lancet.

Zoloft (sertraline) and Remeron (mirtazapine), which are both available as generics, also generated more—and more severe—side effects than placebo, leading the researchers to suggest that these and other antidepressants should be reserved for dementia patients whose depression fails to respond to more conservative treatments, such as psychotherapy.

Although it included just 326 patients, the study is the largest placebo-controlled trial to date on antidepressants in people with dementia. In fact, it is nearly as large as all the previous studies on this topic combined, according to an editorial accompanying the study.

Health.com: 25 signs and symptoms of Alzheimer's disease

More than one-fifth of the 35 million people around the world who have dementia are estimated to also suffer from depression. Despite the limited evidence for the use of antidepressants in this population, some doctors have begun using the drugs - especially sertraline - as a first-line treatment, the researchers say.

Alan Manevitz, M.D., a psychiatrist at Lenox Hill Hospital, in New York City, agrees with the authors' conclusion that doctors should consider nondrug treatments before prescribing antidepressants to depressed dementia patients.

"You don't want to make prescription of antidepressants routine. You should always be thoughtful about why you're introducing [a medication]," says Manevitz, who was not involved in the new study. "This raises the question of whether treatments that don't cause side effects...might have a role in treating depression."

Health.com: Should you stop, adjust, or switch antidepressants?

Led by a team at King's College London, researchers randomly assigned people with a diagnosis of depression and a "probable" or "possible" diagnosis of Alzheimer's disease to receive 150 milligrams of sertraline, 45 milligrams of mirtazapine, or placebo, in addition to their usual care.

Depression symptoms had declined in all three groups after 13 weeks, and again at 39 weeks, but there were no measurable differences between the drug and placebo groups, or between the two drug groups.

Side effects, however, were considerably worse among those taking the drugs. Roughly one-quarter of the people in the placebo group experienced side effects such as nausea or drowsiness, compared with about 40% of the people taking antidepressants. And the side effects in the drug groups were more likely to be considered severe.

"The practical implications of this study are that we should reframe the way we think about the treatment of people with dementia who are depressed, and reconsider the routine prescription of antidepressants," the authors write.

Health.com: Surprising facts about antidepressants

The study is hardly the last word on the subject. It was small, and the findings can't be applied to certain subgroups of patients who were excluded from the study (such as those with severe depression who may be suicidal), to primary care settings, to forms of dementia other than Alzheimer's, or to other types of antidepressants.

Moreover, depression and dementia are both complicated conditions that resist one-size-fits-all treatment and can interact with each other.

Depression - which can impair memory and concentration - sometimes masquerades as dementia, and in some cases may even contribute to dementia, Manevitz says.

Copyright Health Magazine 2011

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Filed under: Alzheimer's • Health.com

soundoff (7 Responses)
  1. PJR

    Effexor was fantastically helpful for my Grandmother with severe agitated dementia. Can't tell me that was a placebo effect, as she didn't notice the difference in the pills when they were changed from something that wasn't helping at all. A number of other drugs were tried and the benefits of the Effexor were obvious with a few weeks.

    BTW, I have zip to do with any drug companies and neither does anyone I know (as far as I know).

    July 20, 2011 at 00:28 | Report abuse | Reply
  2. mouselol

    For myself personally, I've seen first hand the slow progression of this disease and the toll it can take on a family. All those medications do is to slow down the disease and putting off the inevitable, leaving nothing but a shell of a person that once was. If I were ever told that I had alzheimers, I would not want to leave this earth as a vegetable, burdoning my husband, children and potential future grandchildren with the personality changes, and the degration of every ability I have. I'm sorry, but a trip to several pharmacies and several bottles of sleeping pills later I would be gone. Sounds selfish, I know, but I also know the other end of the spectrum and that is not how I want to go.

    July 20, 2011 at 10:36 | Report abuse | Reply
  3. trinnnnity

    My father went through an agitated/paranoid/hostile phase, Zoloft worked like magic for this. He wasn't depressed. And psychotherapy?? Please be reasonable. For example, his parents had passed away 30 years before this and he thought they were still alive and on the farm. Good luck with your psychotherapy.
    And I am very glad he did not kill himself. It is an extremely difficult illness, but we got to know him better and learned more about his life than ever before. Except for the agitated stage, he seemed pretty happy. He had a very strong advanced directive set up, no feeding tubes and all that so it wasn't as difficult a situation as it could have been.

    July 21, 2011 at 00:52 | Report abuse | Reply
    • mouselol

      Yes it wasn't difficult, for you. What about your poor father who physically had to go through this? What about the fear, confusion and losing all of his memories and abilities slowly.
      Like I said in my previous post, I also witnessed this first hand, and from what I saw it for the individual who went through this, it's like being in a bad dream you can't wake from, until there was nothing left of that person lying in bed with blank eyes until his body forgot how to breathe.
      I am sorry for your loss, but witnessing all I did, I would be the first person to help with an assisted suicide if requested as I would do the same thing if I were ever diagnosed. I would rather leave this earth being able to remember my children, my family, and myself for that matter.

      July 21, 2011 at 08:18 | Report abuse |
  4. cbell

    We just put my mom on zoloft, for the anxieties & anxious feeling she gets, not depression it seems to have helped some. Therapy is not an option for a patient in mid to late stage of this disease to suggest is a bit of a joke.

    September 5, 2011 at 23:40 | Report abuse | Reply
  5. twistie

    my father was also recently diagnosed with dementia and has been on Zoloft for 11 years since my mother passed. Family didn't want to see him cry, so in come the anti-depressants. It's too much for too long. Add trazadones for sleep and its no wonder his brain can't think clearly. It makes him incoherant most of the day. Oh well, God forbid, crying may help.

    October 14, 2011 at 22:13 | Report abuse | Reply
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    July 22, 2012 at 20:39 | Report abuse | Reply

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