Change in Cognitive Functioning Following Acute Antidepressant Treatment in Late-Life Depression

Abstract

Objective Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed medications for geriatric depression. The association of late-life depression and cognitive impairment has been well documented. However, there have been few placebo-controlled trials examining the impact of SSRIs on cognitive functioning. Design Pre-post neuropsychological data collected as part of an 8-week, double-blind, placebo-controlled trial of citalopram in depressed patients aged 75 years and older were used to examine change in cognitive functioning. Setting University affiliated outpatient psychiatry clinics. Participants One hundred seventy-four community dwelling men and women 75 years or older with non-psychotic unipolar depression. Measurements Neuropsychological assessments included mental status (Mini-Mental Status Exam), psychomotor speed (WAIS-III Digit Symbol Subtest), reaction time (Choice Reaction Time), visual-spatial skill (Judgment of Line Orientation), executive functioning (Stroop Color/Word Test), and memory (Buschke Selective Reminding Test). Results Differences in the pattern of change by treatment group depended on responder status. Citalopram non-responders were the only group to decline on verbal learning and psychomotor speed. Citalopram responders showed significant improvement in visuospatial functioning compared to non-responders in either condition, but their improvement was not greater than responders on placebo. Citalopram responders showed greater improvement on psychomotor speed than citalopram non-responders, but their improvement was not greater than placebo responders or non-responders. Conclusions Medication may have a deleterious effect on some aspects of cognition among patients age 75 and over who have not responded. This suggests that patients should not be maintained on a medication if they have not had an adequate response.

Depressive symptoms, antidepressant use, and future cognitive health in postmenopausal women: the Women's Health Initiative Memory Study

“…However, antidepressants frequently cause adverse effects in elderly persons and are associated with increased risk of incident falls, lower bone mineral density and fractures, hyponatremia, cardiovascular morbidity, subclinical and clinical strokes, and all-cause mortality (Smoller et al , 2009; Woolcott et al , 2009; Wright et al , 2009; Haney et al , 2010; Coupland et al , 2011; Mark et al , 2011). Furthermore, despite some studies reporting that the cognitive deficits seen in depressed older adults may improve with antidepressant treatment, especially when taking selective serotonin reuptake inhibitors (SSRIs), these findings are not universal (Knegtering et al , 1994; Lee et al , 2007; Bhalla et al , 2009; Culang et al , 2009). Moreover, the magnitude of cognitive improvement seen in patients with LLD is greater in treatment responders (Culang et al , 2009).…”

“…Furthermore, despite some studies reporting that the cognitive deficits seen in depressed older adults may improve with antidepressant treatment, especially when taking selective serotonin reuptake inhibitors (SSRIs), these findings are not universal (Knegtering et al , 1994; Lee et al , 2007; Bhalla et al , 2009; Culang et al , 2009). Moreover, the magnitude of cognitive improvement seen in patients with LLD is greater in treatment responders (Culang et al , 2009). Depressed patients who have persisting deficits in the memory and executive function domains after effective treatment may be at higher risk for conversion to dementia (Steffens et al , 2004).…”

Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment

“…Cognitive side effects may be especially prevalent and impairing in working patients with depression 50 and in patients with late-life depression who do not respond to AD treatment. 51 Augmentation strategies may be beneficial to treat residual cognitive symptoms. Numerous pharmacotherapy augmentation strategies have shown efficacy in MDD, including lithium 52 and atypical APs, 53 but cognitive dysfunction has not been specifically examined in these studies.…”

When ageing meets the blues: Are current antidepressants effective in depressed aged patients?

“…Those two studies had a different design including different lengths of treatment, patients population and age and assessed different outcomes: thus, it is difficult to conclude on the efficacy of citalopram treatment on cognitive dysfunction in depression. Importantly, Culang and colleagues found that citalopram may have a deleterious effect on some aspect of cognitive function in patients aged 75 years or older (Culang et al, 2009). Sertraline did not improve cognitive functions in aged patients with depression and mild to moderate degree of Alzheimer's disease (Weintraub et al, 2010).…”

“…Specifically, 4 weeks treatment with escitalopram improved memory for facial identity for negative stimuli. Citalopram improved cognitive performances in elderly depressed patients with dementia in one study (Nyth et al, 1992), but not in another study enrolling patients with nonpsychotic unipolar depression (Culang et al, 2009). Those two studies had a different design including different lengths of treatment, patients population and age and assessed different outcomes: thus, it is difficult to conclude on the efficacy of citalopram treatment on cognitive dysfunction in depression.…”