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Antidepressant use and cognitive decline in patients with dementia: a national cohort study
Minjia Mo, Tamar Abzhandadze, Minh Tuan Hoang, Simona F. Sacuiu, Pol Grau Jurado, Joana B. Pereira, Luana Naia, Julianna Kele et al.. BMC Medicine, 2025-02-24
Topic: Risk, prevention and care in population studies
We included 18740 patients (10 205 women [54.5%]; mean [SD] age, 78.2[7.4] years), of which 4271 (22.8%) received at least one prescription for an antidepressant. During follow-up, a total of 11912 prescriptions for antidepressants were issued, with selective serotonin reuptake inhibitors (SSRI) being the most common (64.8%). Antidepressant use was associated with faster cognitive decline (β (95% CI) = - 0.30(- 0.39, - 0.21) points/year), in particular sertraline (- 0.25(- 0.43, - 0.06) points/year), citalopram (- 0.41(- 0.55, - 0.27) points/year), escitalopram (- 0.76(- 1.09, - 0.44) points/year), and mirtazapine (- 0.19(- 0.34, - 0.04) points/year) compared with non-use. The association was stronger in patients with severe dementia (initial MMSE scores 0-9). Escitalopram showed a greater decline rate than sertraline. Compared with non-use, dose response of SSRIs on greater cognitive decline and higher risks of severe dementia, all-cause mortality, and fracture were observed. In this cohort study, current antidepressant use was associated with faster cognitive decline; furthermore, higher dispensed doses of SSRIs were associated with higher risk for severe dementia, fractures, and all-cause mortality. These findings highlight the significance of careful and regular monitoring to assess the risks and benefits of different antidepressants use in patients with dementia.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Mo, M., Abzhandadze, T., Hoang, M. T., Sacuiu, S. F., Jurado, P. G., Pereira, J. B., et al. (2025). Antidepressant use and cognitive decline in patients with dementia: a national cohort study. BMC Medicine. https://doi.org/10.1186/s12916-025-03851-3
Vancouver
Mo M, Abzhandadze T, Hoang MT, Sacuiu SF, Jurado PG, Pereira JB, et al. Antidepressant use and cognitive decline in patients with dementia: a national cohort study. BMC Medicine. 2025. doi:10.1186/s12916-025-03851-3. PMID: 39994788.
BibTeX
@article{mo2025-39994788,
author = {Mo, Minjia and Abzhandadze, Tamar and Hoang, Minh Tuan and Sacuiu, Simona F. and Jurado, Pol Grau and Pereira, Joana B. and Naia, Luana and Kele, Julianna and others},
title = {{Antidepressant use and cognitive decline in patients with dementia: a national cohort study}},
journal = {BMC Medicine},
year = {2025},
doi = {10.1186/s12916-025-03851-3},
pmid = {39994788},
url = {https://doi.org/10.1186/s12916-025-03851-3}
}
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Key findings
- We included 18740 patients (10 205 women [54.5%]; mean [SD] age, 78.2[7.4] years), of which 4271 (22.8%) received at least one prescription for an antidepressant.
- During follow-up, a total of 11912 prescriptions for antidepressants were issued, with selective serotonin reuptake inhibitors (SSRI) being the most common (64.8%).
- Antidepressant use was associated with faster cognitive decline (β (95% CI) = - 0.30(- 0.39, - 0.21) points/year), in particular sertraline (- 0.25(- 0.43, - 0.06) points/year), citalopram (- 0.41(- 0.55, - 0.27) points/year), escitalopram (- 0.76(- 1.09, - 0.44) points/year), and mirtazapine (- 0.19(- 0.34, - 0.04) points/year) compared with non-use.
- The association was stronger in patients with severe dementia (initial MMSE scores 0-9).
- Escitalopram showed a greater decline rate than sertraline.
Why it matters
In this cohort of patients with dementia, antidepressant use was associated with faster cognitive decline, and higher dispensed doses of SSRIs were linked to higher risk of severe dementia, fractures, and all-cause mortality. These findings highlight the need for careful and regular monitoring of the risks and benefits of different antidepressants in patients with dementia.
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Study details
- Study designcohort study
- Participants18,740
- Effect size54.5%; 22.8%; 64.8%
- Evidence strengthModerate
How this study scored 66/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BMC Medicine) |
| Journal's citation record | 3 / 4 | BMC Medicine: journal h-index 259 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 4 / 4 | 18,740 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 34 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 11.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 5 / 6 | Cited 21.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 34 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Sara Garcia Ptacek: h-index 39 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Karolinska Institutet: institution h-index 1,477 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39994788) |
| Free to read | 2 / 2 | Free to read |
| Total | 66 / 100 | — |
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