title: Cholinesterase inhibitor adjunctive therapy for cognitive impairment and depressive symptoms in older adults with depression.
abstract: OBJECTIVE
  To review the primary literature regarding the use of cholinesterase inhibitors (ChEIs) as adjunctive therapy for cognitive enhancement and improvement of depressive symptoms for older adults with depression.
  
  
  METHODS
  A literature search of MEDLINE (1950-September 2011) was conducted, using the search term depression in combination with cholinesterase inhibitor, donepezil, galantamine, or rivastigmine. A search of reference citations was conducted to identify additional references.
  
  
  METHODS
  English-language clinical trials were evaluated. Studies that included subjects with Alzheimer's disease, dementia, Parkinson disease, bipolar disorder, or schizophrenia were excluded. Four clinical studies met our criteria.
  
  
  RESULTS
  We identified 4 randomized, double-blind, placebo-controlled trials that ranged in sample size from 20 to 130. Galantamine 16 mg daily was evaluated in 2 trials lasting 8 and 24 weeks. Neither study found a statistically significant difference in measures of cognition or Hamilton Rating Scale for Depression scores. Donepezil augmentation was evaluated in a 1-year and a 2-year trial. Donepezil was found to improve global cognition at 1 year, but the benefit did not persist at year 2. Subjects with mild cognitive impairment at baseline who received donepezil experienced higher depression recurrence than did those who took placebo (p = 0.03); this effect was not observed in cognitively intact subjects (p = 0.39).
  
  
  CONCLUSIONS
  There is no clear benefit for ChEI therapy as an adjunct to antidepressant therapy for depressed older adults.
authors.affiliation: School of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Cara L
authors.initials: CL
authors.lastname: McDermott
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000150:complications / Q000188:drug therapy*; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D000077265:Donepezil; D004359:Drug Therapy, Combination; D005702:Galantamine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007189:Indans / Q000008:administration & dosage / Q000627:therapeutic use; D048448:Phenylcarbamates / Q000008:administration & dosage / Q000627:therapeutic use; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use; D000068836:Rivastigmine
chemical_list: D000928:Antidepressive Agents; D002800:Cholinesterase Inhibitors; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine