Abstract
Objective
Depression is associated with increased mortality in community samples. The use of
antidepressant medication may also increase mortality, however, it is still unclear
whether taking antidepressants before or after a diagnosis of dementia influences
survival.
Design
Retrospective.
Setting
A cohort with a diagnosis of Alzheimer disease (AD) from a large mental health and
dementia care database in South London, linked to hospitalization and mortality data.
Participants
Mild dementia (Mini-Mental State Examination ≥18/30) at the point of diagnosis.
Measurements
We ascertained antidepressant prescription, either in the 6 months before or after
dementia diagnosis, and used the HoNOS65+, a standard clinician-rated measure of patient
well-being, to determine depression severity and other neuropsychiatric, physical
health, and functional difficulties. We conducted a survival analysis, adjusted for
potential confounders and addressed possible confounding by indication through adjusting
for a propensity score.
Results
Of 5473 patients with AD, 22.8% were prescribed an antidepressant in a 1-year window
around dementia diagnosis. Of these, 2415 (44.1%) died in the follow-up period [mean
(standard deviation) 3.5 (2.4) years]. Prescription of an antidepressant, both before
and after dementia diagnosis, was significantly associated with higher mortality after
adjusting for a broad range of potential confounders including symptom severity, functional
status, and physical illness (hazard ratio 1.22; 95% confidence interval 1.08–1.37
for prescription prior to dementia diagnosis; 95% confidence interval 1.04–1.45 for
prescription post dementia diagnosis). In stratified analyses, risks remained significant
in those without neuropsychiatric symptoms.
Conclusions
The prescription of antidepressants around the time of dementia diagnosis may be a
risk factor for mortality.
Keywords
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Article info
Publication history
Published online: August 30, 2017
Footnotes
The Clinical Records Interactive Search (CRIS) system was funded and developed by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King's College London, and by a joint infrastructure grant from Guy's and St Thomas' Charity and the Maudsley Charity. CM and RS authors receive salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
RS has received research funding from Roche, Pfizer, Janssen, Lundbeck, and In-Silico-Bioscience outside the submitted work. None of the authors have any financial arrangements, organizational affiliations, or other relationships that might give rise to any conflict of interest regarding the subject matter of the manuscript submitted.
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© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
