Antidepressant medication accelerates cognitive decline in patients with dementia, according to a study published in BMC Medicine. Some drugs seem less harmful than others, which can help doctors make better treatment decisions.
Antidepressants can be used to treat symptoms such as anxiety, depression, aggressiveness, and sleep disturbances in patients with dementia. However, a new study based on data from the Swedish Dementia Registry (SveDem) suggests that patients treated with antidepressants show more signs of cognitive decline compared to patients who do not receive this medication.
For the study, the team from the Karolinska Institutet analysed 18,740 patients, of which 23% were treated with antidepressants. A total of 11,912 prescriptions of antidepressants were recorded, with selective serotonin reuptake inhibitors (SSRIs) accounting for 65%. The researchers also followed the patients’ cognitive development over time and compared both medicated and non-medicated groups as well as different types of antidepressants.
Although they couldn’t confirm with 100% certainty that the drugs cause cognitive impairment, the researchers noticed that antidepressants were associated with increased cognitive decline. “Depressive symptoms can both worsen cognitive decline and impair quality of life, so it is important to treat them. Our results can help doctors and other healthcare professionals choose antidepressants that are better adapted for patients with dementia,” said Sara Garcia Ptacek, researcher at the Department of Neurobiology, Karolinska Institutet.
The team also detected differences between different drugs. For example, SSRI escitalopram was associated with the fastest cognitive decline, followed by the SSRIs citalopram and sertraline. On the other hand, mirtazapine had a less negative cognitive impact than escitalopram.
In the future, the team wants to check if certain patient groups, such as patients with specific types of dementia, respond better or worse to different antidepressants. “The goal is to find these subgroups to create more individualised care,” concluded Sara Garcia Ptacek.
Mo M, Abzhandadze T, Hoang M, Sacuiu S, et al. (2025) Antidepressant use and cognitive decline in patients with dementia: a national cohort study. BMC Medicine, doi: 10.1186/s12916-025-03851-3.