Association between concurrent antidepressant and hypnotic treatment and the risk of dementia: A nationwide cohort study

Lin, Ching-En; Lee, Meei-Shyuan; Kao, Senyeong; Chung, Chi‐Hsiang; Chen, Lifen; Chou, Po-Han; Lee, Jia-Fu; Chien, Wu-Chien

doi:10.1016/j.jad.2020.08.025

Cited by 5 publications

(6 citation statements)

References 55 publications

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“…However, in a subgroup with depression, sleep disorders and anxiety disorders, negative association was detected. 38 These results indicated inconsistent results oppose the findings regarding positive association between the hypnotics and dementia as discussed. In previous studies, it was suggested that BZDs could reduce brain amyloid deposition for these results.…”

Section: Inconclusive or Lack Of Association Between Hypnotics And De...mentioning

confidence: 83%

“…In other study, patients prescribed concurrent antidepressant and hypnotic treatment, antidepressants alone, and hypnotics alone, all of them were at an increased risk of developing all-cause dementia. However, in a subgroup with depression, sleep disorders and anxiety disorders, negative association was detected [ 38 ]. These results indicated inconsistent results oppose the findings regarding positive association between the hypnotics and dementia as discussed.…”

Section: Inconclusive or Lack Of Association Between Hypnotics And De...mentioning

confidence: 99%

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Association Between Hypnotics and Dementia: A Mini Narrative Review

Yoon,

Kim,

Seo

et al. 2024

Psychiatry Investig

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Objective This narrative review aims to provide a comprehensive assessment of the existing literature on the relationship between hypnotics and dementia, considering both potential link and inconclusive or lack of association.Methods Data from studies that investigate the association between hypnotic medications and dementia were reviewed. Studies included both cohort studies and systematic reviews, participants with various type of dementia and hypnotics including benzodiazepines (BZDs) and Z-drugs (ZDs).Results The existing literatures presents conflicting evidence regarding the association between hypnotics, including BZDs and ZDs, and the risk of dementia. Some studies suggest a potential link between prolonged use of hypnotics and an increased risk of dementia. However, other studies indicate inconclusive or lacking evidence regarding this association. Factors such as study design, sample characteristics, and control of confounding variables contribute to the variability in findings.Conclusion The relationship between hypnotics and dementia remains complex and controversial. While some studies suggest a potential association, others find inconclusive or conflicting evidence. Future research should focus on addressing methodological limitations, considering classifying dementia subtypes, and try to adjust medication lag time.

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Section: Inconclusive or Lack Of Association Between Hypnotics And De...mentioning

confidence: 83%

Section: Inconclusive or Lack Of Association Between Hypnotics And De...mentioning

confidence: 99%

Association Between Hypnotics and Dementia: A Mini Narrative Review

Yoon,

Kim,

Seo

et al. 2024

Psychiatry Investig

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“…We used the CDR which is an especially useful tool tied to functional outcomes rather than to cognitive test performance. By measuring MCI, our work provides information that is not obtainable in the studies from around the world that examine the link between BZD use and dementia in health care, insurance, or pharmacy databases, for example (Aldaz et al ., 2021; Baek et al ., 2020; Gerlach et al ., 2021; Gomm et al ., 2016; Joyce et al ., 2022; Lin et al ., 2020). This being an observational study, we do not expect to establish causality.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepine use and risk of incident MCI and dementia in a community sample

Teverovsky

Gildengers

Ran

et al. 2023

Int. Psychogeriatr.

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Objectives: Older adults commonly take benzodiazepines (BZDs) that may have long-term adverse cognitive effects. We investigated whether BZD use was related to developing mild cognitive impairment (MCI) or dementia in cognitively normal older adults in the community. Setting/Participants: A population-based cohort (n = 1959) of adults aged 65 and over, recruited from communities of low socioeconomic status. Measurements: BZD use, Clinical Dementia Rating (CDR), anxiety symptoms, depression symptoms, sleep difficulties, and APOE genotype. Design: We examined time from study entry to MCI (CDR = 0.5) and time from study entry to dementia (CDR ≥ 1) in participants who were cognitively normal at baseline (CDR = 0). We used survival analysis (Cox model), adjusted for age, sex, education, sleep, anxiety, and depression. For all the models, we included an interaction term between BZD use and APOE*4. Results: Taking BZDs was significantly associated with higher risk of developing MCI, but not of developing dementia. The effect was not affected by APOE genotype. Conclusions: In a population-based sample of cognitively normal older adults, BZD use is associated with developing MCI, but not dementia. BZD use may be a potentially modifiable risk factor for MCI.

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“…There are some reports which suggest that this may be the case [87,88]. However, research in humans reveals a much more equivocal picture [87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102][103]. The results of these studies are summarized in Table 2.…”

Section: Antidepressants and The Risk Of Dementia In Prospective Studiesmentioning

confidence: 99%

“…Others suggest that antidepressants may have a protective effect against dementia in patients with MDD, but may paradoxically increase the risk of dementia in patients with other diagnoses [91,96]. It should also be noted that some studies have failed to show evidence of either a risk or a benefit associated with antidepressant use as a whole [98,100], while others have found an increase in dementia risk [93,95,97]. In a large sample of German adults aged 60 years and above, it was found that antidepressants were protective against dementia only in patients with moderate or severe MDD [91].…”

Section: Antidepressants and The Risk Of Dementia In Prospective Studiesmentioning

confidence: 99%

Resolving a paradox: antidepressants, neuroinflammation, and neurodegeneration

Rajkumar

2024

Explor Neuroprot Ther

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Depression is a known risk factor for dementia. Antidepressants are the most commonly used treatment for this condition, and are effective in at least half to two-thirds of cases. Extensive evidence from in vitro and animal models suggests that antidepressants have anti-inflammatory and neuroprotective properties. These effects have been shown to reduce the oxidative damage, amyloid aggregation, and expression of pro-inflammatory genes associated with animal models of neurodegenerative disorders. However, longitudinal research in humans has shown that antidepressants do not protect against dementia, and may even be associated with a risk of cognitive deterioration over time in older adults. The contrast between two sets of findings represents a paradox of significant clinical and public health significance, particularly when treating depression in late life. This review paper attempts to resolve this paradox by critically reviewing the medium- and long-term effects of antidepressants on peripheral immune-inflammatory responses, infection risk, gut microbiota, and neuroendocrine responses to stress, and how these effects may influence the risk of neurodegeneration. Briefly stated, it is possible that the peripheral actions of antidepressant medications may antagonize their beneficial effects against neuroinflammation. The implications of these findings are then explored with a particular focus on the development and testing of multimodal neuroprotective and anti-inflammatory treatments that could reduce the risk of Alzheimer’s and related dementias in patients suffering from depression.

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Association between concurrent antidepressant and hypnotic treatment and the risk of dementia: A nationwide cohort study

Cited by 5 publications

References 55 publications

Association Between Hypnotics and Dementia: A Mini Narrative Review

Association Between Hypnotics and Dementia: A Mini Narrative Review

Benzodiazepine use and risk of incident MCI and dementia in a community sample

Resolving a paradox: antidepressants, neuroinflammation, and neurodegeneration

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