For years, antidepressants have been the go-to treatment for dementia patients struggling with depression, anxiety, aggression, and sleep disturbances. But new research from the Karolinska Institute suggests they might be doing more harm than good. A study of nearly 19,000 dementia patients found that those taking SSRIs like escitalopram (Lexapro), citalopram (Celexa), and sertraline (Zoloft) experienced faster cognitive decline compared to those not on medication. The findings raise serious questions about whether we’re treating symptoms at the cost of accelerating the disease itself.
This isn’t the first time SSRIs have come under scrutiny. Despite being one of the most widely prescribed drug classes in the world, research suggests they’re often less effective than we think. A major study published in the British Medical Journal (BMJ) found that for mild to moderate depression, SSRIs perform only slightly better than placebo. And the side effects? They’re not minor. Many patients experience cognitive fog, emotional blunting, sexual dysfunction, and increased fall risk—issues that are especially concerning for dementia patients. If SSRIs are already questionable for the general population, should they really be the first-line treatment for people with cognitive impairments?
The good news is that researchers are now working to identify whether certain dementia subtypes or biomarkers influence how patients respond to antidepressants. This could lead to more personalized treatment plans that minimize harm while still addressing mental health needs. In the meantime, doctors and caregivers need to be more selective. Non-drug interventions—like therapy, structured routines, and social engagement—should be explored before reaching for a prescription. If medication is necessary, options like mirtazapine may have a less harmful cognitive impact than traditional SSRIs.
At the end of the day, there is no one-size-fits-all answer when it comes to mental health and dementia care. What works for one person may not work for another. That’s why it’s critical for patients, caregivers, and medical professionals to stay informed, ask questions, and weigh the risks and benefits before making treatment decisions. Research is evolving, and so should our approach.
Bottom line? Don’t take the default route—do your homework. If you or a loved one is facing a decision about antidepressants and dementia, make sure you have all the facts. The best treatment plan is the one that’s right for you.
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