Pharmacotherapy for the treatment of depression in patients with alzheimer’s disease: a treatment-resistant depressive disorder

Abstract

Pharmacotherapy for the treatment of depressive disorders in Alzheimer's Disease (AD) represents a clinical challenge. pharmacological options are often attempted after a period of watchful waiting (8-12 weeks). monoaminergic antidepressant drugs have shown only modest or null clinical benefits, maybe because the etiology of depressive symptoms in ad patients is fundamentally different from that of nondemented subjects. Areas covered: The following article looks at the selective serotonin reuptake inhibitor sertraline, which is one of the most frequently studied antidepressant medications in randomized controlled trials (RCTs). It also discusses many other pharmacological approaches that have proven to be inadequate (antipsychotics, acetylcholinesterase inhibitors, anticonvulsants, hormone replacement therapy) and new drug classes (mainly affecting glutamate transmission) that are being studied for treating depression in AD. It also gives discussion to the phase II RCT on the alternative drug S47445 and the potential effect on cognition of the multimodal antidepressant vortioxetine in older depressed patients. Finally, it discusses the N-methyl-D-aspartate antagonist ketamine. Expert opinion: The present RCT methodologies are too disparate to draw firm conclusions. Future studies are required to identify effective and multimodal pharmacological treatments that efficiently treat depression in AD. Genotyping may boost antidepressant treatment success.

Amygdala: Neuroanatomical and Morphophysiological Features in Terms of Neurological and Neurodegenerative Diseases

“…Depression is common in AD patients, with radically declining quality of life [74,75]. Unfortunately, there is no beneficial pharmacotherapy for such cases, because monoaminergic antidepressants have not shown efficacy [76,77]. It was reported using neuroimaging that these patients have changes in the grey and white matter, and other important brain structures: the prefrontal and temporal cortex, corpus callosum, the posterior cingulate gyrus [78][79][80][81][82].…”

Mirtazapine and Depressions

“…Antipsychotics, acetylcholinesterase inhibitors, anticonvulsants, and hormone replacement therapy have proven to be unhelpful. Studies using novel glutamatergic drugs are ongoing, suggesting that many demented patients may benefit from agents affecting glutamate transmission (Lozupone et al 2018).…”

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

“…Antipsychotics, acetylcholinesterase inhibitors, anti-convulsant and hormonereplacement therapy are all typical treatments that are commonly prescribed to alleviate depression in AD. 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.…”