How Antidepressant Drugs Help with Dementia

By American Geriatrics Society (AGS)

Depression is extremely common in society as a whole, and people with dementia frequently suffer from it. Its symptoms include irritability, loss of interest in doing things, low mood, poor concentration and memory, poor sleep and appetite, tearfulness, thoughts of death and perhaps even suicide.

Depression can also provoke feelings of anxiety and worry.

Dementia plus depression is an unfortunate double whammy that can make the symptoms of the dementia worsen more quickly than in normal disease progression. Treating the depression can therefore make a big difference to the person’s wellbeing.

Understanding how antidepressants work

Antidepressant medications increase the levels of neurotransmitters in the brain that are thought to dip when you have depression. The main transmitters affected are serotonin and norepinephrine. These pills don’t provide a fake dose of these neurotransmitters but increase depleted levels by preventing their breakdown.

Most people find that antidepressants begin to help after a couple of weeks, during which time early side effects may resolve. However, they may take four to six weeks to have maximal effect. Initially they’re continued for 6 to 12 months and then weaned off as a trial. If depressive symptoms return off the antidepressant, then they can be restarted and taken for a longer time. They’re not addictive.

Knowing when doctors prescribe antidepressants

Doctors suggest starting these medicines if significant symptoms of depression have persisted for a period of weeks. These prescription antidepressants aren’t appropriate to use in someone who has just been down in the dumps for a few days.

Alongside their usefulness in treating depression, antidepressants also can help with symptoms of severe anxiety and worry. And evidence suggests that in dementia particularly, they can help reduce agitation and also improve motivation if your loved one has lost interest in life.

Being aware of the side effects and risks of antidepressants

Side effects depend on the type of medication used. Nowadays, doctors most commonly prescribe the SSRIs (selective serotonin reuptake inhibitors) for dementia patients. The main possible side effects of SSRI drugs include the following:

  • Nausea, indigestion, stomach ache, diarrhea or constipation, loss of appetite, weight loss or gain, dry mouth, rash
  • Headaches, tiredness, insomnia, loss of sexual desire, erectile dysfunction in men, and inability to have orgasm in women
  • Less commonly but potentially serious include easy bruising, stomach bleeding, blood in the stools, confusion, tremor, hallucinations, urinary retention

Doctors use them cautiously in people with epilepsy, heart disease, diabetes, and any history of bleeding into the bowel. SSRI drugs can have serious interactions (which can be fatal) with some strong painkillers such as tramadol, so these drugs should never be used at the same time.