Banerjee S et al. ?Depression is common in dementia but the evidence base for appropriate drug treatment is sparse and equivocal. The authors aimed to assess efficacy and safety
of two of the most commonly prescribed drugs, sertraline and mirtazapine, compared with placebo. Because of the absence of benefit compared with placebo and increased risk of
adverse events, the present practice of use of these antidepressants, with usual care, for first-line treatment of depression in Alzheimer's disease should be reconsidered.
Methods
- We undertook the parallel-group, double-blind, placebo-controlled, Health Technology Assessment Study of the Use of Antidepressants for Depression in Dementia (HTA-SADD)
trial in participants from old-age psychiatry services in nine centres in England
- Participants were eligible if they had probable or possible Alzheimer's disease, depression (lasting &ge4 weeks), and a Cornell scale for depression in dementia (CSDD)
score of 8 or more
- Participants were ineligible if they were clinically critical (eg, suicide risk), contraindicated to study drugs, on antidepressants, in another trial, or had no carer
- Clinical trials unit at King's College London (UK) randomly allocated participants with computer-generated block randomisation sequence, stratified by centre, with varying
block sizes, in a 1:1:1 ratio to receive sertraline (target dose 150 mg per day), mirtazapine (45 mg), or placebo (control group), all with standard care
- Primary outcome reduction in depression (CSDD score) at 13 weeks (outcomes to 39 weeks were also assessed), assessed with mixed linear-regression model adjusted for baseline
CSDD, time, and treatment centre
Results
- Decreases in depression scores at 13 weeks did not differ between 111 controls and 107 participants allocated to receive sertraline (mean difference 1?17, 95% CI -0?23 to
2?58; p=0?10) or mirtazapine (0?01, -1?37 to 1?38; p=0?99), or between participants in mirtazapine and sertraline groups (1?16, -0?25 to 2?57; p=0?11); these findings persisted
to 39 weeks
- Fewer controls had AE (29 of 111 [26%]) than did participants in sertraline group (46 of 107, 43%; p=0?010) or mirtazapine group (44 of 108, 41%; p=0?031), and fewer serious
AE rated as severe (p=0?003)
- 5 patients in every group died by week 39
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