Antidepressants

Antidepressants contribute to dementia. Classes of antidepressants include: 

• tricyclic antidepressants (TCA), 
• selective serotonin reuptake inhibitors (SSRIs), 
• monoamine oxidase inhibitors (MAOIs), and 
• serotonin and norepinephrine reuptake inhibitors (SNRIs). 

Tricyclic antidepressants have strong anticholinergic side effects and a high risk of drug-induced dementia. A population-based retrospective case-control study analyses 5,394 patients who had major depression and were diagnosed with dementia and 5,232 patients who had major depression but no dementia. The study results showed that antidepressant use increased the risk of dementia. However, SSRIs and TCA’s increased the risk of dementia more than other antidepressants. Of note, people who were diagnosed with dementia were more likely to have diabetes, hypertension, stroke, and head injury. 

Opiates And NSAIDs

A study assessed whether opioid or NSAID use is associated with a higher risk of dementia risk or cognitive decline. The participants (n=3,434) were aged 65 and older, did not have dementia, and had received standardized doses of opioids or NSAID medications over 10 years. The results showed that 797 participants (23%) who used opioids developed dementia over a median follow-up of 7.5 years while 637 (19%) had possible or probable Alzheimer's disease.  A similar pattern was seen with NSAID use. Heavier opioid use was not associated with a more rapid cognitive decline. The conclusion of the study was that people with the heaviest opioid or NSAID use had slightly higher dementia risk than people with little or no use but opioid use does not convey substantial long-term cognitive decline.

References:

Starr J, Whalley L. Drug-induced dementia. Incidence, management, and prevention. Drug safety.1994;11(5):310–7. 

Lin RY, Heacock LC, Fogel JF. Drug-induced, dementia-associated and non-dementia, non-drug delirium hospitalizations in the United States, 1998–2005. Drugs & Aging. 2010;27(1):51–61. 

Alagiakrishnan K, Wiens CA. An approach to drug induced delirium in the elderly. Postgraduate Medical Journal. 2004;80(945):388–393. 

Billioti de Gage S, Bégaud B, Bazin F, Verdoux H, Dartigues JF, Pérès K, Kurth T, Pariente A. Benzodiazepine use and risk of dementia: prospective population based study. BMJ 2012;345. 

Do benzodiazepines increase the risk of dementia? From NPS Medicinewise 

Dublin S, Walker RL, Gray SL, et al. Prescription Opioids and Risk of Dementia or Cognitive Decline: A Prospective Cohort Study. Journal of the American Geriatrics Society. 2015;63(8):1519-1526.

Cynthia Wei-Sheng Lee, PhD; Cheng-Li Lin, MSc; Fung-Chang Sung, PhD; Ji-An Liang, MD; and Chia-Hung Kao, MD. Antidepressant Treatment and Risk of Dementia: A Population-Based, Retrospective Case-Control Study. J Clin Psychiatry 2016;77(1):117–122

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