Clinical Topics

Increasing Usage of SSRIs for Dementia Symptoms

by U.S. Medicine

November 29, 2018

DALLAS—Emerging data has suggested effectiveness for selective serotonin reuptake inhibitors for treatment of behavioral and psychological symptoms of dementia.

That is why clinicians now sometimes opt to use SSRIs instead of off-label antipsychotics, a traditional treatment for the condition, according to a study in The Mental Health Clinician.

Researchers from the VA North Texas Healthcare System and Texas Tech University Health Sciences Center sought to evaluate the prevalence of antipsychotic discontinuation six months after SSRI initiation for the treatment of BPSD.

Included in the study were 36 patients with Alzheimer dementia who were prescribed an antipsychotic and later prescribed an SSRI for BPSD during Jan. 1, 2009, through Dec. 30, 2014. Exclusions include those with (1) a dementia diagnosis other than Alzheimer; (2) scheduled benzodiazepines, mood stabilizers, or non-SSRI antidepressant use during the study period; (3) diagnoses of bipolar or psychotic disorders; and (4) diagnosis of delirium during the study period.

Researchers collected patients’ age, sex, race and functional assessment of staging for Alzheimer disease scores were collected, while also recording types, dosages and discontinuation dates of SSRIs and antipsychotics.

The study team reported that, Overall, antipsychotic use was reduced in 11 patients (30.6%). Another 10 patients (27.8%) discontinued the antipsychotic, and one additional patient had a reduction in dose. When comparing specific SSRIs, 8 (72%) responders were prescribed citalopram, and 15 (60%) nonresponders were prescribed sertraline.

“Approximately 30% of patients with Alzheimer dementia who were prescribed antipsychotics for BPSD were able to discontinue the medication or had a dose reduction after starting SSRI therapy. Most SSRI responders were prescribed citalopram,” study authors pointed out.

1. Mathys M, Fang S, John J, Carter J. Antipsychotic discontinuation after the initiation of selective serotonin reuptake inhibitors therapy for the treatment of behavioral and psychological symptoms associated with dementia. Ment Health Clin. 2018 Apr 26;8(3):122-126. doi: 10.9740/mhc.2018.05.122. eCollection 2018 May. PubMed PMID: 29955557; PubMed Central PMCID: PMC6007639.

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