Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study
Abstract Background Prior studies suggested that antidepressant use is associated with an increased risk of dementia compared to no use, which is subject to confounding by indication. We aimed to compare the dementia risk among older adults with depression receiving first-line antidepressants (i.e.,...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-023-04475-z |
| _version_ | 1797397743078998016 |
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| author | Grace Hsin-Min Wang Wei-Han Chen Shao-Hsuan Chang Tianxiao Zhang Hui Shao Jingchuan Guo Wei-Hsuan Lo-Ciganic |
| author_facet | Grace Hsin-Min Wang Wei-Han Chen Shao-Hsuan Chang Tianxiao Zhang Hui Shao Jingchuan Guo Wei-Hsuan Lo-Ciganic |
| author_sort | Grace Hsin-Min Wang |
| collection | DOAJ |
| description | Abstract Background Prior studies suggested that antidepressant use is associated with an increased risk of dementia compared to no use, which is subject to confounding by indication. We aimed to compare the dementia risk among older adults with depression receiving first-line antidepressants (i.e., SSRI/SNRI) versus psychotherapy, which is also considered the first-line therapy for depression. Methods This retrospective cohort study was conducted using the US Medical Expenditure Panel Survey from 2010 to 2019. We included adults aged ≥ 50 years diagnosed with depression who initiated SSRI/SNRI or psychotherapy. We excluded patients with a dementia diagnosis before the first record of SSRI/SNRI use or psychotherapy. The exposure was the patient’s receipt of SSRI/SNRI (identified from self-report questionnaires) or psychotherapy (identified from the Outpatient Visits or Office-Based Medical Provider Visits files). The outcome was a new diagnosis of dementia within 2 years (i.e., survey panel period) identified using ICD-9/ICD-10 codes from the Medical Conditions file. Using a multivariable logistic regression model, we reported adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We also conducted subgroup analyses by patient sex, age group, race/ethnicity, severity of depression, combined use of other non-SSRI/SNRI antidepressants, and presence of underlying cognitive impairment. Results Among 2,710 eligible patients (mean age = 61 ± 8, female = 69%, White = 84%), 89% used SSRIs/SNRIs, and 11% received psychotherapy. The SSRI/SNRI users had a higher crude incidence of dementia than the psychotherapy group (16.4% vs. 11.8%), with an aOR of 1.36 (95% CI = 1.06–1.74). Subgroup analyses yielded similar findings as the main analyses, except no significant association for patients who were aged < 65 years (1.23, 95% CI = 0.93–1.62), male (1.34, 95% CI = 0.95–1.90), Black (0.76, 95% CI = 0.48–1.19), had a higher PHQ-2 (1.39, 95% CI = 0.90–2.15), and had underlying cognitive impairment (1.06, 95% CI = 0.80–1.42). Conclusions Our findings suggested that older adults with depression receiving SSRIs/SNRIs were associated with an increased dementia risk compared to those receiving psychotherapy. |
| first_indexed | 2024-03-09T01:15:34Z |
| format | Article |
| id | doaj.art-579670ec101b4fc4b90b50d44ea90462 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-09T01:15:34Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-579670ec101b4fc4b90b50d44ea904622023-12-10T12:31:05ZengBMCBMC Geriatrics1471-23182023-12-0123111010.1186/s12877-023-04475-zAssociation between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort studyGrace Hsin-Min Wang0Wei-Han Chen1Shao-Hsuan Chang2Tianxiao Zhang3Hui Shao4Jingchuan Guo5Wei-Hsuan Lo-Ciganic6Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of FloridaDepartment of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of FloridaDepartment of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of FloridaDepartment of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of FloridaHubert Department of Global Health, Rollin School of Public Health, Emory UniversityDepartment of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of FloridaCenter for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of PittsburghAbstract Background Prior studies suggested that antidepressant use is associated with an increased risk of dementia compared to no use, which is subject to confounding by indication. We aimed to compare the dementia risk among older adults with depression receiving first-line antidepressants (i.e., SSRI/SNRI) versus psychotherapy, which is also considered the first-line therapy for depression. Methods This retrospective cohort study was conducted using the US Medical Expenditure Panel Survey from 2010 to 2019. We included adults aged ≥ 50 years diagnosed with depression who initiated SSRI/SNRI or psychotherapy. We excluded patients with a dementia diagnosis before the first record of SSRI/SNRI use or psychotherapy. The exposure was the patient’s receipt of SSRI/SNRI (identified from self-report questionnaires) or psychotherapy (identified from the Outpatient Visits or Office-Based Medical Provider Visits files). The outcome was a new diagnosis of dementia within 2 years (i.e., survey panel period) identified using ICD-9/ICD-10 codes from the Medical Conditions file. Using a multivariable logistic regression model, we reported adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We also conducted subgroup analyses by patient sex, age group, race/ethnicity, severity of depression, combined use of other non-SSRI/SNRI antidepressants, and presence of underlying cognitive impairment. Results Among 2,710 eligible patients (mean age = 61 ± 8, female = 69%, White = 84%), 89% used SSRIs/SNRIs, and 11% received psychotherapy. The SSRI/SNRI users had a higher crude incidence of dementia than the psychotherapy group (16.4% vs. 11.8%), with an aOR of 1.36 (95% CI = 1.06–1.74). Subgroup analyses yielded similar findings as the main analyses, except no significant association for patients who were aged < 65 years (1.23, 95% CI = 0.93–1.62), male (1.34, 95% CI = 0.95–1.90), Black (0.76, 95% CI = 0.48–1.19), had a higher PHQ-2 (1.39, 95% CI = 0.90–2.15), and had underlying cognitive impairment (1.06, 95% CI = 0.80–1.42). Conclusions Our findings suggested that older adults with depression receiving SSRIs/SNRIs were associated with an increased dementia risk compared to those receiving psychotherapy.https://doi.org/10.1186/s12877-023-04475-zAntidepressantsPsychotherapyDepressionDementiaOlder adults |
| spellingShingle | Grace Hsin-Min Wang Wei-Han Chen Shao-Hsuan Chang Tianxiao Zhang Hui Shao Jingchuan Guo Wei-Hsuan Lo-Ciganic Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study BMC Geriatrics Antidepressants Psychotherapy Depression Dementia Older adults |
| title | Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study |
| title_full | Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study |
| title_fullStr | Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study |
| title_full_unstemmed | Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study |
| title_short | Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study |
| title_sort | association between first line antidepressant use and risk of dementia in older adults a retrospective cohort study |
| topic | Antidepressants Psychotherapy Depression Dementia Older adults |
| url | https://doi.org/10.1186/s12877-023-04475-z |
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