Alzheimer's & Antidepressants: Is There a Link?

Antidepressants are commonly used to treat depression and anxiety. Research shows that in adults age 60 and older, 19.1 percent took an antidepressant in the past month. Antidepressant use is more common with increasing age.¹

Dementia is a general term for memory loss and other cognitive problems that interfere with daily life. Alzheimer’s disease is the most common cause of dementia.²

About 5.8 million people in the United States age 65 and older have Alzheimer’s disease. Most – 80 percent – are age 75 years or older.³

Are Alzheimer’s disease and antidepressant use related?

The jury is still out, but so far, research shows that there may be a connection between Alzheimer’s disease and certain antidepressants.

A meta-analysis was published in 2018 in a journal called Behavioral Neurology. A meta-analysis looks at multiple studies. For this meta-analysis, the researchers started with over 700 studies and narrowed the analysis down to 5 studies.⁴

This study concluded that antidepressants are “significantly associated” with an increased risk of dementia and should be carefully prescribed, especially in older adults. However, the studies evaluated only tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors), which are not first-choice antidepressants.⁴

Another study looked at about 3,000 people age 65 years and older. This study looked at SSRIs (selective serotonin reuptake inhibitors, the most popularly prescribed antidepressants) and tricyclic antidepressants.⁵

This study concluded that most antidepressants are not associated with dementia risk. However, drugs that have an anticholinergic effect, including tricyclic antidepressants, may be the exception in older adults. Paxil® (paroxetine) is an SSRI that has anticholinergic effects.⁵

Anticholinergic medicines are used to treat many different conditions. However, they can cause many troublesome side effects. Anticholinergic drugs should be used with caution in older adults. Older adults are more vulnerable to these side effects, such as memory and cognitive problems.⁶

The Beers List (Beers Criteria for Potentially Inappropriate Medication Use in Older Adults) contains information about medicines that are not as safe for older adults. The list includes the following antidepressants with “high anticholinergic activity.” It is important to note that these are all tricyclic antidepressants, except the SSRI paroxetine:⁷

• Amitriptyline (Elavil, Vanatrip)
• Amoxapine (Asendin)
• Clomipramine (Anafranil)
• Desipramine (Norpramin)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Nortriptyline (Aventyl, Pamelor)
• Paroxetine (SSRI) (Paxil, Paxil CR)
• Protriptyline (Vivactil)
• Trimipramine (Surmontil)

Considerations before taking antidepressants

Some research shows that antidepressants are associated with a higher risk of dementia, especially Paxil, tricyclic antidepressants, and MAOIs. Scientists need to do more research to learn more about the connection between various drugs and Alzheimer’s disease.

Doctors prescribe antidepressants cautiously, especially in older adults. Talk to your doctor about any questions and concerns you have about antidepressants.

If you take an antidepressant, notify your doctor of any problems with memory or thinking. Your doctor may stop the medicine or change you to a different medicine. They will give you instructions on tapering off or switching the drug to avoid withdrawal side effects.

Tell each doctor and specialist you see about any medical conditions you have, as well as your family history.

Tell your doctors about every medicine you take. This includes prescription and over-the-counter (OTC) drugs, as well as vitamins and supplements.