Sertraline for the treatment of depression in Alzheimer disease: week-24 outcomes.
BACKGROUND
Depression and antidepressant use are common in Alzheimer disease (AD), but the effect of antidepressant treatment for depression on longer term outcomes is unknown. The authors report the Week-24 outcomes of patients who participated in a 12-week efficacy study of sertraline for depression of AD.


METHODS
One hundred thirty-one participants (sertraline = 67, placebo = 64) with mild-moderate AD and depression participated in the study. Patients who showed improvement on the modified Alzheimer's Disease Cooperative Study Clinical Global Impression-Change (mADCS-CGIC) after 12 weeks of randomized treatment with sertraline or placebo continued double-blinded treatment for an additional 12 weeks. Depression response and remission at 24 weeks were based on mADCS-CGIC score and change in Cornell Scale for Depression in Dementia (CSDD) score. Secondary outcome measures included time to remission, nonmood neuropsychiatric symptoms, global cognition, function, and quality of life.


RESULTS
One hundred seventeen (89.3%) participants completed all study assessments and 74 (56.5%; sertraline = 38, placebo = 36) completed all 24 weeks on randomized treatment. By 24 weeks, there were no between-group differences in depression response (sertraline = 44.8%, placebo = 35.9%; odds ratio [95% CI] = 1.23 [0.64-2.35]), change in CSDD score (median difference = 0.6 [95% CI: -2.26 to 3.46], chi2 [df = 2] = 1.03), remission rates (sertraline = 32.8%, placebo = 21.8%; odds ratio [95% CI] = 1.61 [0.70-3.68]), or secondary outcomes. Common selective serotonin reuptake inhibitor-associated adverse events, specifically diarrhea, dizziness, and dry mouth, and pulmonary serious adverse events were more frequent in sertraline-randomized patients than in placebo subjects.


CONCLUSIONS
Sertraline treatment is not associated with delayed improvement between 12 and 24 weeks of treatment and may not be indicated for the treatment of depression of AD.
Weintraub
Daniel
D
Section of Geriatric Psychiatry, University of Pennsylvania and Mental Illness Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. daniel.weintraub@uphs.upenn.edu
Rosenberg
Paul B
PB
Drye
Lea T
LT
Martin
Barbara K
BK
Frangakis
Constantine
C
Mintzer
Jacobo E
JE
Porsteinsson
Anton P
AP
Schneider
Lon S
LS
Rabins
Peter V
PV
Munro
Cynthia A
CA
Meinert
Curtis L
CL
Lyketsos
Constantine G
CG
D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D010349:Patient Compliance / Q000706:statistics & numerical data; D011788:Quality of Life; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use*
D000928:Antidepressive Agents; D020280:Sertraline