Evidence Review: Antidepressants for Frail Older Adults with Depression or Neuropsychiatric Symptoms of Dementia

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Polypharmacy, the use of more medications than is clinically necessary, is a significant problem among frail, older adults. With this in mind, we appraised the evidence for the efficacy and safety of antidepressants in frail, older adults, as they appear to be commonly prescribed to older adults who are frail. For example, in long-term care, where many frail, older adults reside, antidepressants are the second most commonly prescribed medication, with 60% of residents using an antidepressant and 36% using a selective serotonin reuptake inhibitor (SSRI). Although antidepressants may be prescribed for several conditions, we reviewed evidence on the efficacy of antidepressants for depression and the neuropsychiatric symptoms (NPS) of dementia, as these are frequent conditions in frailty. NPS refers to behavioural and affective symptoms commonly experienced in dementia (e.g., depression, wandering, resistance, agitation, aggression, sexually inappropriate behaviour, and change in sleep patterns). The use of antidepressants for NPS of dementia is an off-label indication, however, there has been increasing interest in the efficacy and safety of antidepressants for NPS due to concerns about the risks of stroke and death from antipsychotics. The evidence for non-drug (psychosocial) interventions was not assessed in this review.

Laurie Mallery, MD, FRCPC, MSM is a Professor of Geriatric Medicine at Dalhousie University, and a physician at the Centre of Health Care for the Elderly, a multi-service institution based out of the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia. Dr. Mallery obtained her BSc in Science from the City University of New York – Hunter Collage, and subsequently obtained her MD from the University of Pennsylvania. Dr. Mallery completed her residency training at Presbyterian St. Luke’s Hospital in Chicago, Illinois and her subspecialty training in Geriatric Medicine at Dalhousie University/Halifax Infirmary Hospital. Her principal research interests are the assessment and treatment of dementia, education, and exercise in older adults. Dr. Mallery co-founded Palliative and Therapeutic Harmonization (PATH) which offers services for older people with serious health conditions, including those who are frail.

Constance LeBlanc, DSS, MD, CCFP, FCFP, MAEd is Associate Dean, Office of Continuing Professional Development and Association Professor and Director of Education, Department of Emergency Medicine at Dalhousie University. She completed her Diploma in Health Sciences at Université de Moncton, her medical training at Université Laval, and her Masters in Medical Education at Mount Saint Vincent University.

Dr. Michael Allen, MD, MSc graduated from Dalhousie Medical School in 1976.  He worked as a family physician in rural and urban areas of Nova Scotia for 17 years before joining Dalhousie Continuing Professional Development in 1994. Since joining Dalhousie CME he has helped provide CPD to community physicians through face-to-face programming, videoconferencing, webinars and academic detailing. He completed a Masters in Community Health and Epidemiology in 2011 and is now retired and living in Ottawa but still helps out with interesting projects.