Update on SSRI Treatment for Neuropsychiatric Symptoms of Dementia

Abstract

Neuropsychiatric symptoms (NPS) of dementia including agitation, depression, and psychosis are common and debilitating facets of the disease process. Despite the significant impact of these symptoms on both individuals with dementia and their caregivers, safe and effective treatment options are lacking. From a pharmacological approach, antipsychotics have historically been the treatment of choice, but these medications are only modestly effective with significant adverse effects. Behavioral and psychosocial interventions have been shown to be effective but are difficult to implement in routine clinical practice. SSRI medications have been investigated as an alternative psychopharmacological approach based on evidence that the serotoninergic system is involved in the etiology of NPS in dementia. The evidence base for using SSRI medications in the treatment of NPS is growing, but the applicability of research findings to the utility of SSRIs in general in routine clinical practice is not entirely clear at this point. Further studies of a variety of SSRI medications in targeting NPS are needed to make a more definitive assessment of the efficacy of these medications in the relief of NPS.

A cross-sectional examination of the prevalence of psychotropic medications for people living with dementia in Australian long-term care facilities: issues of concern

“…This is thought to be due to depression in dementia being a result of damage to the brain and thus fundamentally different to depression in individuals without dementia (Wilkins and Forester, 2016). There is evidence, however, that SSRIs may be effective in treating agitation in this population (Wilkins and Forester, 2016). The regression results suggest that antidepressants were most likely to be prescribed to younger depressed residents, rather than agitated residents.…”

“…Clinical guidelines (#87 and #88) caution against the use of antidepressants for depression in individuals with dementia, due to little evidence of their efficacy (Guideline Adaptation Committee, 2016). This is thought to be due to depression in dementia being a result of damage to the brain and thus fundamentally different to depression in individuals without dementia (Wilkins and Forester, 2016). There is evidence, however, that SSRIs may be effective in treating agitation in this population (Wilkins and Forester, 2016).…”

Depression in Alzheimer’s Disease: An Alternative Role for Selective Serotonin Reuptake Inhibitors?

“…However many of these drugs have been found to be inadequate [67] in treating depression in AD and as a result SSRI's are more widely prescribed. SSRI's are often associated with a reduced risk of an adverse event [68,69], and are therefore considered safer.…”

Management of Neuropsychiatric Symptoms of Dementia: A Comprehensive Review of the Current Literature

“…Prevalence of depression in patients with dementia is as high as 40% [14] and antidepressants have been studied not only to target depressive symptoms, but also to treat behavioral disturbances. A Cochrane review by Seitz et al [62] looked at studies comparing SSRIs to placebo, typical, and atypical antipsychotics.…”

“…NPS has also been associated with negative outcomes such as faster progression of dementia and increased mortality. Additionally, poor quality of life, functional decline, higher healthcare costs, reduced time to institutionalization, and caregiver distress are other common negative outcomes [5,[9][10][11][12][13][14][15].…”