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

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 the...

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Bibliographic Details
Published in:	PloS one 2017-04, Vol.12 (4), p.e0175187-e0175187
Main Authors:	Then, Chee-Kin, Chi, Nai-Fang, Chung, Kuo-Hsuan, Kuo, Lynn, Liu, Kao-Hui, Hu, Chaur-Jong, Shen, Shing-Chuan, Lin, Yen-Kuang
Format:	Article
Language:	eng
Subjects:	Adult Adults Affective disorders Alzheimer's disease Amine oxidase (flavin-containing) Amitriptyline Analysis Anticholinergics Antidepressants Antidepressive Agents - therapeutic use Anxiety Atrophy Attention Biocompatibility Biology and Life Sciences Biomedical materials Cancer Care and treatment Case-Control Studies Cell proliferation Cerebrospinal fluid Citalopram Clinical medicine Cognitive ability Cytotoxicity Dementia Dementia - drug therapy Dementia disorders Diagnosis Dosage and administration Drugs Electrolytic cells Emergency medical services Fatigue Female Growth factors Health care Health insurance Health risk assessment Health risks Hip Hippocampus Homeostasis Humans Hyperlipidemia Inflammation Inhibitors Low back pain Male Medical personnel Medicine Medicine and Health Sciences Mental depression Mental disorders Mental health Mice Middle Aged Mood Neurodegenerative diseases Neurology Older people Pain Pharmacology Population studies Populations Psychiatry Psychotropic drugs Risk analysis Risk Assessment Risk factors Risk reduction Side effects Taiwan Toxicity β-Amyloid
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Summary:	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 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.
ISSN:	1932-6203 1932-6203