Reviewed by Joel Salinas, MD
A new study in BMC Medicine found that certain antidepressants — especially a group called SSRIs (like escitalopram, citalopram, and sertraline) — seem to be linked to faster memory and thinking problems in people living with dementia. This was an observational study that provided real-world information from many different patients, but it wasn’t a controlled experiment. Because of this, we can’t say for sure that antidepressants directly caused the increased decline.
Below, we’ll explore potential reasons for these findings, how to balance depression treatment with protecting brain function, and what these results could mean for those caring for someone with dementia.
Why certain antidepressants might be linked with faster cognitive decline
The study highlighted SSRIs like escitalopram, citalopram, and sertraline as possibly linked to faster cognitive decline. Scientists aren’t entirely sure why some antidepressants might make thinking and memory problems worse, but there are a few possibilities:
- Changes in Brain Chemistry: SSRIs adjust levels of a brain chemical called serotonin. In a brain already affected by dementia, these changes might have unexpected consequences that speed up memory or thinking problems.
- Anticholinergic Effects: Some antidepressants also block a different neurotransmitter called acetylcholine, which is very important for memory and learning. People with dementia are particularly vulnerable to problems if this action is further reduced.
- Natural Dementia Progression: It could also be that those who needed stronger or more frequent antidepressants already had more severe dementia symptoms. Since this research wasn’t tightly controlled, we don’t know whether the medication or the advanced dementia (or both) caused the faster decline.
It’s difficult to parse exactly why SSRIs are linked to faster cognitive decline, because dementia isn’t the same for everyone. Factors like genetics, type of dementia, and other health conditions could make some individuals more sensitive to SSRIs. There are also limitations in the study itself. Because it’s difficult to tell who was given SSRIs and why in an observational study, researchers will need to conduct further, rigorous studies to know if SSRIs directly contribute to cognitive decline or if other factors are at play.
Balancing depression treatment and brain health
Untreated depression can itself worsen dementia by leading to social withdrawal, low motivation, and less mental stimulation. As such, avoiding antidepressants completely is not always recommended. Here are a few considerations:
- Tailored Medication Choices. Healthcare providers can help select antidepressants that may carry fewer potential risks for making cognitive problems worse. Sometimes, this means trying different medications and tracking results carefully.
- Non-Medication Approaches. In addition to — or sometimes instead of — antidepressants, techniques such as talk therapy, music therapy, light exercise, and social activities may help ease depression symptoms without risking more memory loss.
- Regular Check-Ins. If an antidepressant is used, it’s essential to monitor both mood and thinking abilities. That way, healthcare providers can spot any negative changes and adjust treatment promptly.
What this means for healthcare providers
Healthcare providers may be even more cautious when prescribing antidepressants to people with dementia. We recommend always doing a thorough medication review. Reviewing all medications a person is taking — especially ones that can affect brain chemicals — can help reduce any harmful “pile-on” effect.
In certain cases, it may also be advantageous to use the lowest effective dose of depression medication. It’s possible that higher doses might carry a greater risk, while more moderate doses still offer benefits for mood without significantly increasing cognitive decline. More research is needed to understand the safest and most effective dose ranges.
What this means for patients and caregivers
It’s important to note that these findings are based on early evidence, and SSRIs have previously been found to be safe and provide a notable benefit in older adults, including those with dementia. One earlier study showed favorable outcomes for using SSRIs in older populations. Because of this, no one should stop or change their medication on their own. Abruptly stopping an antidepressant can lead to withdrawal symptoms and a sudden worsening of both mood and cognitive problems.
Patients living with dementia and depression may also benefit from incorporating brain health-friendly changes into their daily habits. Studies have shown that a healthy diet, exercise, and engaging social activities all play a vital role in supporting brain health. These measures can often be combined with medication to boost overall well-being.
Overall, this study shines a light on the need for more controlled trials to pin down exactly how antidepressants affect people with dementia. Supporting or participating in future research can help shape better care.
Final thoughts
Although these results warrant attention, they shouldn’t overshadow the fact that many people with dementia benefit significantly from antidepressants. If you have any concerns about medication use for yourself or a loved one, it’s best to speak with a healthcare provider — particularly a geriatrician, psychiatrist, or neurologist — who can advise you on your specific situation.
Isaac Health’s multidisciplinary team is also here to help. Our neurologists, psychiatrists, psychologists, and other dementia-trained specialists can help individuals with dementia get the support they need for both their mood and cognitive health. Call us at (888) 818-2059 today or book a free initial consultation.
