Antidepressant Use and Cognitive Functioning in Older Medical Patients With Major or Minor Depression A Prospective Cohort Study With Database Linkage

Department of Internal Medicine and Program on Aging, Yale University, New Haven, CT 06511, USA.
Journal of clinical psychopharmacology (Impact Factor: 3.24). 06/2011; 31(4):429-35. DOI: 10.1097/JCP.0b013e318221b2f8
Source: PubMed


The long-term cognitive effect of antidepressant medications in older persons is not well understood, especially in those with minor depression and complex medical conditions. The objective of this study is to examine this relationship in older medical patients with different depression diagnoses.
281 medical inpatients aged 65 years and older from 2 acute care hospitals in Montreal, Canada, were diagnosed as with major or minor depression or without depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. They were followed up with the Mini-Mental State Examination for cognitive function and the Hamilton Depression Rating Scale for depressive symptoms at baseline and 3, 6, and 12 months after discharge. Antidepressant medication was ascertained from a provincial prescription database and quantified as cumulative exposures over each follow-up interval.
During the 12-month follow-up period, 1027 antidepressant prescriptions were filled. The most frequently prescribed antidepressant agents were citalopram (0.81 prescriptions per person), sertraline (0.76), and paroxetine (0.66). Antidepressant use was not associated with cognitive changes among patients with major depression or without depression but was associated with an increased Mini-Mental State Examination score in patients with minor depression (1.4 points; 95% confidence interval, 0.1-2.6), independent of change in the severity of depression symptoms, concomitant benzodiazepine or psychotropic drug use, and other potentially important confounders.
In this cohort of older medical patients, antidepressant use for 12 months did not lead to significant cognitive impairment. The small cognitive improvement among minor depression associated with antidepressant use deserves further investigation.

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    • "Other pharmacological agents affecting cognitive function in depression: antidepressant therapy, bupropion, S-Adenosyl methionine (SAMe), galantamine and donepezil augmentation, and acute tryptophan depletion (ACT) This section evaluates studies employing various pharmacological agents to investigate effects on cognitive performance in depression. In a prospective cohort study with database linkage 281 elderly medical inpatients were diagnosed with major, minor or no depression and followed up with the MMSE and the HAM-D over 1 year to examine the relationship between antidepressant medication and long-term cognitive effects (Han et al., 2011). The authors found an association between antidepressant medication and cognitive improvement in minor depression, but not in major or no depression. "
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    • "The conventional MLR strategy simply added the depression-related diagnoses, AEP Vol. -, No. - Han et al. -2011: - ANTIDEPRESSANT USE, COGNITIVE IMPAIRMENT, AND CONFOUNDING BY INDICATION and then both the depression-related diagnoses and CES-D score (referred hereafter as Index MLR) to the reference model, whereas the PS strategy involved two steps. In the first step, a PS for initial antidepressant prescribing was estimated for each participant by the use of a logistic regression model, in which antidepressant use at baseline (yes versus no) was regressed on a set of potential predictors, including depression-related diagnoses, CES-D score, systolic and diastolic blood pressure, and indicators for eight individual comorbidities. "
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