A Systematic Review and Meta‐Analysis of Placebo‐Controlled Antidepressant Studies in People with Depression and Dementia

Nelson, J. Craig; Devanand, Davangere P.

doi:10.1111/j.1532-5415.2011.03355.x

Cited by 263 publications

(141 citation statements)

References 42 publications

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“…The potential for a negative effect of depression above and beyond other BPSD on caregivers is especially important given that depression is highly prevalent among patients with AD with estimates ranging up to 40%. (33;34) While pharmacological treatment efforts for depression in dementia are common, their efficacy is not proven(35), and usage remain complicated due to polypharmacy and difficulty assessing symptom change in patients due to cognitive impairment(36). Developing and testing more effective strategies for treating depression in patients with dementia may improve outcomes for the patient and the caregiver.…”

Section: Discussionmentioning

confidence: 99%

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

Ornstein

Gaugler

Devanand

et al. 2013

The American Journal of Geriatric Psychiatry

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Objectives The behavioral and psychological symptoms associated with dementia (BPSD) are highly burdensome to caregivers. While BPSD consist of a wide variety of patient behaviors including depression, physical aggression and paranoid delusions, it remains unclear whether specific symptoms have a differential impact on caregivers. The aims of this study were (1) to assess how individual BPSD symptoms, categorized based on how they may affect caregivers, impact depressive symptoms for dementia patient caregivers and (2) to test the pathways by which BPSD symptom clusters impact caregiver depressive symptoms. Design Cross-sectional analysis of data from a longitudinal study of patients with Alzheimer’s disease and Dementia with Lewy Bodies. Setting Multiple U.S. dementia clinics. Participants 160 patient-caregiver dyads. Methods Using multivariate GEE logistic models, we analyzed the relationship between four BPSD symptom clusters (patient depressive symptoms, accusatory/aggressive behaviors, non-threatening psychotic symptoms, and difficult to manage behaviors) and caregiver depressive symptoms and assessed mediators of these relationships. Results Only the presence of patient depressive symptoms was associated with caregiver depression (OR=1.55; 95% CI=1.14–2.1). This relationship was mediated by both caregiver report of the symptom’s impact on the patient and perceived burden to caregivers. Conclusions Patient depressive symptoms may be the most important driver of the relationship between BPSD and caregiver depression. Research in this field should further test the effects of individual BPSD symptoms and should also consider how symptoms may negatively impact caregivers by increasing burden and evoking empathy for the patient.

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Section: Discussionmentioning

confidence: 99%

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

Ornstein

Gaugler

Devanand

et al. 2013

The American Journal of Geriatric Psychiatry

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“…Das Demenz risiko ist verdoppelt [5,6]. Systematische Übersichts arbeiten und Metaanalysen zeigen allenfalls mode rate Effekte für die Wirksamkeit von Antidepressiva bei älteren Depressiven [7][8][9]. Die epidemiologischen Daten, die mit Altersdepressionen verbundenen er heblichen Risiken und die nicht zufriedenstellenden pharmakotherapeutischen Möglichkeiten legen die Frage nach a nderen s innvollen T herapieansätzen nahe.…”

Section: Psychotherapie Der Altersdepressionunclassified

Psychotherapie der Altersdepression

2015

Swiss Arch Neurol Psychiatr

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“…On the other hand, antidepressant drugs and electroconvulsive therapy (ECT) have not shown significant effect on depression in AD. A meta-analysis revealed that selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors did not show significant effect on depression in AD 14 . A randomized controlled trial (RCT) with a large sample, also revealed that neither selective serotonin reuptake inhibitors nor noradrenergic and specific serotonergic antidepressants showed superiority to placebo, and concluded that antidepressants should not be used first for depression in AD considering adverse events induced by antidepressants 15 .…”

mentioning

confidence: 99%

Commentary: Transcranial direct current stimulation for depression in Alzheimer's disease: study protocol for a randomized controlled trial

Yokoi¹

2017

J Neurol Neuromedicine

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Dementia is a progressive neurodegenerative disorder that is characterized by a decline in cognition in one or more cognitive domains such as learning and memory, language, executive function, complex attention, perceptual-motor, social cognition . The cholinergic drugs, introduced first in 1997, have been approved worldwide and considered to be the first line pharmacotherapy for mild to severe AD. The mechanism of these drugs is to inhibit the breakdown of acetylcholine, a neurotransmitter associated with memory or cognitive activity, by blocking the enzyme acetylcholinesterase 10 . Although these drugs can slow the progression of AD, a review study revealed the limited efficacy of these compounds 10 . Future disease-modifying treatments and therapeutic interventions augmenting current pharmacologic treatments are awaited.Neuropsychiatric symptoms in patients with AD also compromise their QOL 11. Depressive mood is one of the most frequent neuropsychiatric symptoms in AD as well as agitation and apathy 12. The prevalence rate of depression in AD is estimated as from 36.7 % 13 to 47.8 % 12. On the other hand, antidepressant drugs and electroconvulsive therapy (ECT) have not shown significant effect on depression in AD. A meta-analysis revealed that selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors did not show significant effect on depression in AD 14. A randomized controlled trial (RCT) with a large sample, also revealed that neither selective serotonin reuptake inhibitors nor noradrenergic and specific serotonergic antidepressants showed superiority to placebo, and concluded that antidepressants should not be used first for depression in AD considering adverse events induced by antidepressants 15 . Moreover, a recent thorough review, in neither older patients over 65 years nor patients with dementia, verified the effect of ECT 16 .Our recent study entitled "Transcranial direct current stimulation for depression in Alzheimer's disease: study protocol for a randomized controlled trial" was designed to evaluate the safety and effect of transcranial direct current stimulation (tDCS) on depression in patients with AD over 65 years 17 . tDCS is a simple, cheap, and safe technique of neuromodulation, based on the application of weak, direct electrical current to the brain through relatively large electrodes. Two

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A Systematic Review and Meta‐Analysis of Placebo‐Controlled Antidepressant Studies in People with Depression and Dementia

Cited by 263 publications

References 42 publications

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

The Differential Impact of Unique Behavioral and Psychological Symptoms for the Dementia Caregiver: How and Why Do Patients' Individual Symptom Clusters Impact Caregiver Depressive Symptoms?

Psychotherapie der Altersdepression

Commentary: Transcranial direct current stimulation for depression in Alzheimer's disease: study protocol for a randomized controlled trial

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