Limits...
Risk analysis of use of different classes of antidepressants on subsequent dementia: A nationwide cohort study in Taiwan

View Article: PubMed Central - PubMed

ABSTRACT

Depression and dementia are common mental health problems and are associated in several ways. Early-life depression is associated with increased risk of later life dementia, and depression can present as a preclinical symptom or consequence of dementia. Despite the plausible relationship between these two clinical entities, the potential association between antidepressant medication and dementia has rarely been investigated. We conducted a 9-year retrospective analysis of Taiwan’s National Health Insurance Research Database (NHIRD), enrolling 5819 cases who had received prescriptions of antidepressants between 2003 and 2006, and 23,276 (with ratio of 1:4) age, sex, and index date-matched controls. The hazard ratio (HR) of dementia among antidepressant users with depression was 2.42 (95% confidence interval (CI): 1.15–5.10), for those without depression was 4.05 (95% CI: 3.19–5.15), compared to antidepressant non-users respectively. Among the 6 classes of common antidepressants used in Taiwan, the adjusted HRs were 3.66 (95% CI: 2.62–5.09) for SSRIs, 4.73 (95% CI: 2.54–8.80) for SNRI, 3.26 (95% CI: 2.30–4.63) for TCAs, 6.62 (95% CI: 3.34–13.13) for TeCA, 4.94 (95% CI: 2.17–11.24) for MAOI, and 4.48 (95% CI: 3.13–6.40) for SARI. Furthermore, the multivariate analysis result showed that the adjusted HRs of cumulative defined daily doses (cDDDs) were 3.74 (95% CI: 2.91–4.82), 3.73 (95% CI: 2.39–5.80) and 5.22 (95% CI: 3.35–8.14) for those who had cDDDs of <90, 90–180 and >180 compared to those who had taken no antidepressant medication. This is a retrospective study based on secondary data, hence, we could not claim causality between antidepressant medication and dementia. However, a potential association between antidepressant and occurrence of dementia after controlling for the status of depression was observed. Lack of patients’ data about smoking status and body mass index in NHIRD, which are considered related to dementia, was also a limitation in this study. In this study, we concluded that antidepressant medication is a potential risk factor for dementia, independent from any effect of depression itself.

No MeSH data available.


Related in: MedlinePlus

Forest plot of factors associated with the incidence of dementia.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5383251&req=5

pone.0175187.g003: Forest plot of factors associated with the incidence of dementia.

Mentions: In the pathogenesis of dementia, both ideas that mention depression as a risk factor for dementia and depression as a prodromal symptom remain controversial. It is difficult to clarify the causal relation between depression and dementia, and findings in the previous literature are inconsistent on these issues [10, 38, 39]. We found that dementia is a possible pathological consequence since patients with depression had higher incidence of dementia (HR = 1.59, 95% CI: 1.11–2.27) (Table 5). This finding is consistent with previous studies that identified depression as one of the risk factors of dementia [9, 10]. Considering the potential confounding effect of depression on dementia in this study, we first examined the interaction effect between depression status and antidepressant usage and then tested the antidepressant effect for depression and non-depression groups. The adjusted HR of dementia in depression group was 2.42 (95% CI: 1.15–5.10), while for non-depression group, it was 4.05 (95% CI: 3.19–5.15) (Table 2). Our result shows that antidepressant users had higher hazard ratio of dementia, which indicated that antidepressant medication is a potential risk factor for dementia and is independent of depression and other well-known risk factors, such as age, CCI score, stroke, diabetes, hypertension, hyperlipidemia, insomnia, and anxiety (Fig 3). Again, this result suggested that dementia may be an iatrogenic result of taking antidepressant medication, besides the pathogenic consequence of depression.


Risk analysis of use of different classes of antidepressants on subsequent dementia: A nationwide cohort study in Taiwan
Forest plot of factors associated with the incidence of dementia.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383251&req=5

pone.0175187.g003: Forest plot of factors associated with the incidence of dementia.
Mentions: In the pathogenesis of dementia, both ideas that mention depression as a risk factor for dementia and depression as a prodromal symptom remain controversial. It is difficult to clarify the causal relation between depression and dementia, and findings in the previous literature are inconsistent on these issues [10, 38, 39]. We found that dementia is a possible pathological consequence since patients with depression had higher incidence of dementia (HR = 1.59, 95% CI: 1.11–2.27) (Table 5). This finding is consistent with previous studies that identified depression as one of the risk factors of dementia [9, 10]. Considering the potential confounding effect of depression on dementia in this study, we first examined the interaction effect between depression status and antidepressant usage and then tested the antidepressant effect for depression and non-depression groups. The adjusted HR of dementia in depression group was 2.42 (95% CI: 1.15–5.10), while for non-depression group, it was 4.05 (95% CI: 3.19–5.15) (Table 2). Our result shows that antidepressant users had higher hazard ratio of dementia, which indicated that antidepressant medication is a potential risk factor for dementia and is independent of depression and other well-known risk factors, such as age, CCI score, stroke, diabetes, hypertension, hyperlipidemia, insomnia, and anxiety (Fig 3). Again, this result suggested that dementia may be an iatrogenic result of taking antidepressant medication, besides the pathogenic consequence of depression.

View Article: PubMed Central - PubMed

ABSTRACT

Depression and dementia are common mental health problems and are associated in several ways. Early-life depression is associated with increased risk of later life dementia, and depression can present as a preclinical symptom or consequence of dementia. Despite the plausible relationship between these two clinical entities, the potential association between antidepressant medication and dementia has rarely been investigated. We conducted a 9-year retrospective analysis of Taiwan’s National Health Insurance Research Database (NHIRD), enrolling 5819 cases who had received prescriptions of antidepressants between 2003 and 2006, and 23,276 (with ratio of 1:4) age, sex, and index date-matched controls. The hazard ratio (HR) of dementia among antidepressant users with depression was 2.42 (95% confidence interval (CI): 1.15–5.10), for those without depression was 4.05 (95% CI: 3.19–5.15), compared to antidepressant non-users respectively. Among the 6 classes of common antidepressants used in Taiwan, the adjusted HRs were 3.66 (95% CI: 2.62–5.09) for SSRIs, 4.73 (95% CI: 2.54–8.80) for SNRI, 3.26 (95% CI: 2.30–4.63) for TCAs, 6.62 (95% CI: 3.34–13.13) for TeCA, 4.94 (95% CI: 2.17–11.24) for MAOI, and 4.48 (95% CI: 3.13–6.40) for SARI. Furthermore, the multivariate analysis result showed that the adjusted HRs of cumulative defined daily doses (cDDDs) were 3.74 (95% CI: 2.91–4.82), 3.73 (95% CI: 2.39–5.80) and 5.22 (95% CI: 3.35–8.14) for those who had cDDDs of <90, 90–180 and >180 compared to those who had taken no antidepressant medication. This is a retrospective study based on secondary data, hence, we could not claim causality between antidepressant medication and dementia. However, a potential association between antidepressant and occurrence of dementia after controlling for the status of depression was observed. Lack of patients’ data about smoking status and body mass index in NHIRD, which are considered related to dementia, was also a limitation in this study. In this study, we concluded that antidepressant medication is a potential risk factor for dementia, independent from any effect of depression itself.

No MeSH data available.


Related in: MedlinePlus