Antidepressants for depression in patients with dementia: a review of the literature.
OBJECTIVE
To evaluate the literature investigating the efficacy and safety of antidepressants for treating depression in individuals with dementia.


METHODS
A literature search was conducted using MEDLINE, PUBMED, EMBASE, and Cochrane databases from inception to May 2013 for studies in English that evaluated the treatment of depression in patients with dementia. All relevant randomized controlled trials (RCTs) and meta-analyses were identified using the search terms "dementia" or "Alzheimer's disease," and "depression" or "major depressive disorder." Reference lists from retrieved articles and practice guidelines were also searched for relevant literature.


METHODS
Only randomized, placebo-controlled trials and meta-analyses that compared an antidepressant with placebo for the treatment of depression in patients with dementia were included.


RESULTS
In this systematic review, 10 RCTs and 3 meta-analyses were identified that examined the efficacy and safety of antidepressants compared with placebo in treating depression in patients with dementia. The majority of the RCTs consisted of a small sample size, and the antidepressants studied were not routinely used in practice.


CONCLUSIONS
The evidence for antidepressants in the treatment of depression in patients with dementia is inconclusive. The accumulation of evidence suggests nonpharmacologic approaches and watchful waiting be attempted for the first 8 to 12 weeks in a patient who presents with both mild-to-moderate depression and dementia. In cases of severe depression, or depression not managed through nonpharmacologic means, a trial of an antidepressant may be initiated. However, further well-designed trials are needed to support these recommendations.
faculty of pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.
Christine
C
Leong
D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D003863:Depression / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic
D000928:Antidepressive Agents
AD = Alzheimer's disease; Alzheimer's disease; Antidepressants; CSDD = Cornell Scale for Depression in Dementia; DIADS-2 = Depression in Alzheimer's Disease Study-2; Dementia; Depression; HAM-D or HDRS = Hamilton Depression Rating Scale; HTA-SADD = Sertraline or Mirtazapine for Depression in Dementia; MADRS = Montgomery-Asberg Depression Rating Scale; MMSE = Mini-Mental State Examination; NINCDS-ADRDA = National Institute of Neurological and Communicative Diseases and Stroke - Azheimer's Disease and Related Disorders Association; RCT = Randomized controlled trial; SSRI = Selective serotonin reuptake inhibitor; mADCS-CGIC = Modified Alzheimer's Disease Cooperative Study - Clinical Global Impression of Change