Reacción a "A study associates a type of antidepressant with accelerated cognitive decline in people with dementia"

This study has several elements that give it robustness, such as the size of the sample and that this sample can be said to be population-based (it incorporates the entire Swedish population with dementia). This fact is relevant because there are few databases in the world that have this type of information at their disposal.

However, a cause-effect relationship cannot be determined between treatment with antidepressants and the average decrease in the MMSE score (which the authors themselves already acknowledge). First of all, it must be taken into account that the treatment is to modify a situation (depressive mood) that in Alzheimer's disease and other dementias can be camouflaged among the cognitive deterioration itself, or be a consequence of it. At the same time, the brain where these symptoms appear is much more deteriorated than in the general population with depression where the treatment studies have been carried out. It should also be added that the MMSE is a screening test for cognitive deterioration and that it is not a specific instrument to measure amnesic alterations but that the deterioration can affect other domains.

In the analysis by dementia subtypes and by drug subtypes it is relevant and, once again, it is a pleasure to know that there is a registry with this power to be able to carry out this type of work. However, the specific reason why the treatment has been prescribed is not stated, because depending on the symptoms, one type of drug is more appropriate than another, while depending on the type of injury, some types of symptoms are more likely than others. For example, the appearance of apathetic symptoms in vascular dementia is known, while the use of Mirtazapine can occur in patients who present insomnia and/or loss of appetite. There are notable differences between citalopram and escitalopram, with the former having the least impact – although, at some point, there were doubts as to whether the latter would be the only option of the commercial company.

The reason or the specialist who has incorporated these treatments in the patients is also not stated, so few conclusions can be drawn beyond the already known caution regarding these drugs. This caution should be increased in Spain, as it is one of the European countries with the highest prescription of antidepressants and benzodiazepines, mostly to older people.