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The risk of dementia is greater among elderly patients with major depressive disorder (MDD) who are resistant to antidepressant medication, according to study findings published in The American Journal of Geriatric Psychiatry.
Investigators explored the association between depression medication and risk of subsequent dementia using ICD-9 codes and administrative claims data from the Taiwan National Health Insurance Research Database. They conducted an observational study that included deidentified patients at least 50 years of age who received their first MDD diagnosis between 2001 and 2011 (30,390 patients with MDD; 24,312 well-matched controls). Participants were stratified by both selective serotonin reuptake inhibitors (SSRIs) vs non-SSRIs, and by antidepressant-resistant depression (ART; n=6078) and antidepressant-responsive depression (ARP; n=24,312).
A significantly greater prevalence of depression-related comorbidities (cerebrovascular diseases, diabetes, dyslipidemia, hypertension) were found among patients with ART vs ARP or controls. No between-group differences were found for the percentage of women, age at depression diagnosis, or level of urbanization.
Compared with controls, both ART and ARP groups had a greater risk of developing dementia (5-fold to 24-fold), and patients in the ART group vs those in the ARP group may have had a greater risk of developing any dementia (hazard ratio [HR], 13.02; 95% CI, 11.08-15.31 vs HR, 7.70; 95% CI, 6.63-8.94), respectively, or unspecified dementia (HR, 12.81; 95% CI, 10.52-15.59 vs HR, 7.33; 95% CI, 6.11-8.79), respectively.
In the ART group, subanalysis suggested patients resistant to SSRIs only (HR, 12.01; 95% CI, 10.02-14.40) or resistant to both SSRIs and non-SSRIs (HR, 13.87; 95% CI, 11.67-16.47) vs those in the ARP group may have had a greater risk of developing any dementia (HR, 7.70; 95% CI, 6.63-8.94).
Study limitations included the possibility of reverse causation, the observational design, inherent errors in administrative claims data, and unmeasured confounders. Additionally, drug adherence (poor adherence common among older patients with MDD) was unknown. “Patients with antidepressant-resistant depression were more likely to develop dementia than those with antidepressant-responsive depression,” the investigators concluded, “We did not find different risks of subsequent dementia in elderly patients with major depressive disorders receiving different classes of antidepressants.”
This article originally appeared on Psychiatry Advisor
