Cited by 13Dementia and Cognitive Impairment ResearchTreatment of Major DepressionPharmaceutical Practices and Patient Outcomes

The DOI matches its Crossref record; 36 of the 38 references it cites were found in a registry or an index; 20 of the 32 sources its claims cite were checked for support.

Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study

Open access

Published version of a preprint

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.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In this retrospective cohort of US adults aged ≥50 with depression, first-line SSRI/SNRI use was associated with higher 2-year dementia risk than psychotherapy. The adjusted odds ratio was 1.36 (95% CI 1.06–1.74), with no significant association in several subgroups.

Key findings

  • Among 2,710 eligible patients (mean age 61 ± 8; 69% female; 84% White), 89% used SSRIs/SNRIs and 11% received psychotherapy.
  • Crude dementia incidence within 2 years was 16.4% in SSRI/SNRI users vs 11.8% in the psychotherapy group; adjusted OR was 1.36 (95% CI 1.06–1.74), and the marginal effect was 31.0% (95% CI 6.6–55.3%).
  • Subgroup analyses were mostly consistent, but no significant association was found for patients aged <65 years (aOR 1.23, 95% CI 0.93–1.62), male (1.34, 0.95–1.90), Black (0.76, 0.48–1.19), PHQ-2 score 3–6 (1.39, 0.90–2.15), or underlying cognitive impairment (1.06, 0.80–1.42).
  • Sensitivity analyses yielded similar findings: aOR 1.27 (95% CI 1.18–1.37) with 1:1 propensity score matching and 1.12 (95% CI 1.05–1.20) when removing comedications from propensity score estimation.

Methods

  • Retrospective cohort using 2010–2019 US Medical Expenditure Panel Survey data; included adults aged ≥50 with depression diagnosed in round 1 or 2 who initiated SSRI/SNRI or psychotherapy, excluding concomitant use of both, missing cognitive impairment data, and dementia before the index round.
  • Exposure was SSRI/SNRI use from prescribed medicines questionnaires vs psychotherapy from outpatient/office-based visit files; outcome was new dementia within the 2-year survey panel identified by ICD-9/ICD-10 codes from the Medical Conditions file.
  • Analysis used multiple imputation, propensity score trimming, stabilized inverse probability treatment weighting, and survey-weighted multivariable logistic regression with a doubly robust approach; subgroup and sensitivity analyses were also performed.

Limitations

  • The paper states MEPS follows patients for at most 2 years, which may underestimate dementia risk; lack of washout period prevented identifying incident new users and addressing depletion of susceptibles; duration of depression, death as a competing risk, and SSRI/SNRI dose and duration were unavailable.
  • The paper also notes small sample sizes after stratification as a possible reason for null subgroup findings.
  • Evident from the text: this is an observational study using self-reported medication data and administrative diagnosis codes, so residual confounding and exposure/outcome misclassification remain possible.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12877-023-04475-z

Cites

36 of 36 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 Study population selection. From the 2010-2019 MEPS data, we identified 17,040 patients diagnosed with depression at round 1 or 2, of which 10,215 patients used SSRI/SNRI at round 1 or 2. Each panel in MEPS data includes 5 rounds within 2 years. The reason for limiting to the first two rounds was to allow at least one year follow-up time for each patient. We excluded patients combining SSRI/SNRI with psychotherapy at any round (n=2.842), aged <50 years at round 1 (n=4106), missed cognitive impairment data at any round (n=29), and diagnosed with dementia before the index round (n=528). There were 2,710 patients included in out analytical cohort, with 2,402 (89%) using SSRIs/SNRIs and 308 (11%) receiving psychotherapy.
Fig. 1 Study population selection. From the 2010-2019 MEPS data, we identified 17,040 patients diagnosed with depression at round 1 or 2, of which 10,215 patients used SSRI/SNRI at round 1 or 2. Each panel in MEPS data includes 5 rounds within 2 years. The reason for limiting to the first two rounds was to allow at least one year follow-up time for each patient. We excluded patients combining SSRI/SNRI with psychotherapy at any round (n=2.842), aged <50 years at round 1 (n=4106), missed cognitive impairment data at any round (n=29), and diagnosed with dementia before the index round (n=528). There were 2,710 patients included in out analytical cohort, with 2,402 (89%) using SSRIs/SNRIs and 308 (11%) receiving psychotherapy.CC BY · PubMed Central
Fig. 2 Distribution of propensity scores in the exposed (i.e., SSRI/SNRI) and unexposed (i.e., psychotherapy) groups. This figure shows that the propensity scores of the SSRI/SNRI and psychotherapy groups highly overlapped with each other after trimming
Fig. 2 Distribution of propensity scores in the exposed (i.e., SSRI/SNRI) and unexposed (i.e., psychotherapy) groups. This figure shows that the propensity scores of the SSRI/SNRI and psychotherapy groups highly overlapped with each other after trimmingCC BY · PubMed Central

Verification

Claims the paper makes

22 Own result · 10 No full text of the sources · 9 Partly supported · 9 Own method · 4 Supported · 3 Couldn’t confirm · 3 Own interpretation · 2 No basis given · 1 Not supported · 1 Sources not found · 1 Not checked yet · accuracy not yet measured

  • Probably not a substantial claim. 14
  • It may state two separate claims as one. 11
  • The quote only partly states this claim. 3
26 of 26
  • The paper relies on this without support.

    No unmeasured confounding remains after adjustment for measured covariates and propensity score methods.

    “we aimed to compare the risk of dementia among older adults using SSRIs/SNRIs (i.e., first-line pharmacological treatments) versus those on psychotherapy, adjusting for patients’ demographics, socioeconomic status, comorbidities, comedications, and most importantly, the severity of depression to minimize confounding by indication.”
  • The paper relies on this without support.

    MEPS data accurately capture SSRI/SNRI use and psychotherapy receipt.

    “We identified SSRI/SNRI use from the questionnaires in the prescribed medicines files using therapeutic classification variables from Cerner Multum, Inc. (Appendix Table 1). Psychotherapy used was identified from the Outpatient Visits or Office-Based Medical Provider Visits files.”
  • The paper relies on this without support.

    The two-year survey panel period is sufficient to detect incident dementia associated with SSRI/SNRI use.

    “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.”
    “We followed up patients until the dementia outcome occurred or the end of each survey panel period (i.e., two years).”
3 of 3

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Citations

Cites

Show all 38 references

Research works printed but not linked: 1

  1. Wedding D. In: Corsini RJ, editor. Current psychotherapies: Cengage Learning; 2013.

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Metadata

Authors
Wang, G. H.-M., Chen, W.-H., Chang, S.-H., Zhang, T., Shao, H., Guo, J., & Lo-Ciganic, W.-H.
Affiliations
  • University of Florida (US)
  • Emory University (US)
Venue
BMC Geriatrics
Published
2023-12-08
Volume
23
Issue
1
Pages
825-825
ISSN
1471-2318 (ISSN-L)
OpenAlex
W4389475855
Cited by
13
References
38
Citations by year
2026: 7 · 2025: 2 · 2024: 4
FWCI
2.19
Type
journal article
Language
en
Open access
Locations
  • BMC Geriatrics (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institute of Mental Health (R01MH121907)
  • National Institute on Drug Abuse (R01DA050676, R01DA044985)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
antidepressant use, dementia risk, older adults, depression, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, psychotherapy, confounding by indication, cognitive impairment, sex differences, racial and ethnic differences, depression severity, polypharmacy, antidepressant safety, Medicare claims data, PHQ-2

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