Swedish researchers found that antidepressants may accelerate cognitive decline in dementia patients, with some medications posing greater risks than others.
At a Glance
- A large Swedish study of 18,740 dementia patients found that antidepressant use was associated with faster cognitive decline
- Higher doses of SSRIs (Selective Serotonin Reuptake Inhibitors) were linked to severe dementia, fractures, and increased mortality
- Certain antidepressants showed more harmful effects than others, with escitalopram causing the fastest cognitive decline
- Men on antidepressants experienced more rapid cognitive deterioration than women
- Experts caution that depression itself may contribute to cognitive decline, making it difficult to determine causality
Concerning Findings from Swedish Research
A comprehensive study from Sweden has raised serious concerns about prescribing antidepressants to patients with dementia. Researchers from Karolinska Institutet and Sahlgrenska University Hospital analyzed data from 18,740 dementia patients in the Swedish Dementia Registry (SveDem), discovering that those treated with antidepressants experienced more rapid cognitive decline compared to untreated patients. Approximately 23% of subjects received antidepressant treatment, with Selective Serotonin Reuptake Inhibitors (SSRIs) accounting for 65% of prescriptions.
The findings come at a critical time, as depression affects up to half of all dementia patients. Antidepressants are routinely prescribed to manage not only depression but also anxiety, aggressiveness, and sleep disturbances in this vulnerable population. The study has significant implications for the nearly 10% of American adults 65 and older who have dementia, with another 22% experiencing mild cognitive impairment.
So antidepressants may speed up cognitive decline:
A new study based on data from 18,740 dementia patients suggests that antidepressants may accelerate cognitive decline. Researchers found that patients taking antidepressants, particularly SSRIs like escitalopram, citalopram,…
— The Sirius Report (@thesiriusreport) February 26, 2025
Differences Between Medications
The Swedish research revealed substantial variations in how different antidepressants affect cognitive function in dementia patients. Escitalopram was associated with the fastest cognitive decline, followed by citalopram and sertraline – all common SSRIs prescribed to seniors. In contrast, mirtazapine, which works through different mechanisms, demonstrated less negative impact on cognitive function.
The study also uncovered troubling gender differences, with men on antidepressants showing faster cognitive deterioration than women receiving similar treatment. Higher doses of SSRIs correlated with increased rates of severe dementia, fractures, and mortality. These findings suggest that physicians should consider both the type of antidepressant and appropriate dosing when treating dementia patients, particularly male patients who may be more vulnerable to negative effects.
Medical Community Urges Caution
While the study presents compelling evidence, medical experts urge measured interpretation of the results. The research could not definitively determine whether cognitive decline resulted from the medications themselves or from underlying depressive symptoms. Depression is known to impair cognitive function independently.
Some neurologists also worry about potential overreactions to the study’s findings. Dr. Richard Isaacson expressed concern that families might prematurely discontinue helpful medications based on misinterpretation of the research.
The Swedish researchers are now focusing on identifying patient subgroups who might respond differently to various antidepressants, aiming to develop more individualized treatment approaches. This is particularly important given that a 2019 review found antidepressants often ineffective for depression in Alzheimer’s patients, suggesting that current treatment protocols may need significant revision.
