Does antidepressant therapy improve cognition in elderly depressed patients?
OBJECTIVE
To analyze the effects of antidepressants on cognitive functioning in elderly depression.


METHODS
Data were pooled for elderly participants with major depression from two double-blind 12-week studies (n = 444) comparing sertraline to fluoxetine and to nortriptyline. A cognitive battery was performed pre-treatment and post-treatment that included the Shopping List Task (SLT), which quantifies short-term and long-term memory storage and retrieval, and the Digit Symbol Substitution Test (DSST), which measures visual tracking, motor performance, and coding.


RESULTS
Older age, male gender, higher systolic blood pressure, and higher illness severity were associated with lower performance on specific cognitive measures at baseline. For the entire group, improved depression and a lower anticholinergic side effect (dry mouth and constipation) severity were associated with statistically significant improvement in the SLT and DSST. The correlations between improvements in depression and improvement in tested cognitive function were highest for sertraline followed by nortriptyline and then fluoxetine.


CONCLUSIONS
Acute improvement in depression is associated with cognitive improvement as measured by the SLT and DSST. Prospective studies are warranted to study the effects of potential differences among antidepressant therapies on long-term cognitive outcomes in geriatric depression.
Doraiswamy
P Murali
PM
Departments of Psychiatry and Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. dorai001@md.duke.edu
Krishnan
K Ranga Rama
KR
Oxman
Thomas
T
Jenkyn
Lawrence R
LR
Coffey
David J
DJ
Burt
Tal
T
Clary
Cathryn M
CM
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000517:prevention & control; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009661:Nortriptyline / Q000008:administration & dosage; D011336:Probability; D012016:Reference Values; D020280:Sertraline / Q000008:administration & dosage; D012720:Severity of Illness Index; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000928:Antidepressive Agents; D005473:Fluoxetine; D009661:Nortriptyline; D020280:Sertraline