Several studies released recently – here we will focus on two of them: one a two-year study with a large group of elderly (over 65 years of age) participants and the a broader study tracking neurological changes associated with dementia that included participants of all ages – have raised significant red flags about the use of antidepressants and the increased risk of dementia associated with that.
Antidepressant use – prescribed and non-prescribed (I admit I am still surprised when I hear people say “I just got a ____________ (fill in the blank) from my friend because I was depressed and I felt better so now when I need one I just go and get it from them”) – is now ubiquitous in the Western world.
As the senior author, Dr. Darrell Mousseau, of one of the studies we will summarize states, “They’re [antidepressants] being prescribed ‘off label,’ meaning for nondepression related situations. They’re being prescribed to very young children and to the very old. They’re almost becoming the antibiotic of this century: ‘If you’ve got a disease, take an SSRI [selective serotonin reuptake inhibitor]. It’s going to help you in one way, shape or form.”
Before I go any further, let me say that there are people who, not only benefit from, but in fact need, antidepressants so I am not wholesale dismissing the efficacy of these medications for a select group of people for whom they are effective.
However, every medication (and medical treatment of any kind, for that matter), no matter what its efficacy and benefits, has side effects. Therefore, a thoughtful risk analysis weighing the benefits versus the risks and a careful examination to understand the cause of a medical issue and to treat that cause correctly should be undertaken.
In the case of depression, there has been a wealth of new neuroscience research in the last two years that has completely blown the “one-size-fits-all” assumption that all depression stems solely from a problem with the neurotransmitters serotonin and noradrenaline (which the whole class of SSRIs, including Prozac, Effexor, and Zoloft, among others, targets) out of the water.
So the overprescribing of SSRIs both for depression and off-label uses not related to depression is the equivalent of malpractice. And its potentially endangering the long-term neurological health of a lot of people.
The first study that looked at the relationship between antidepressants and the increased risk of developing dementia was conducted over two years and involved over 3,500 elderly people.
The outcome of that study showed a much higher risk of developing dementia in the participants who were taking antidepressants than the participants with depression who were not prescribed antidepressants.
One of the significant and dangerous side effects of SSRIs that the study uncovered – and was very likely a factor in the increased dementia risk – is that SSRIs caused serious disruptions in sleep.
The second study, done in Canada, suggests that the risk of developing dementia is twice as high for people taking SSRIs than it is for people not taking them.
The most startling finding of this study showed that people under 65 years of age who were taking SSRIs had a even higher risk of developing dementia than people 65 or older who were taking SSRIs.
There is a place for SSRIs. There are people for whom the benefit is specific, targeted, and greater than the risks.
However, the liberal and bullet-spraying prescribing policy among medical professionals – who, quite frankly, don’t, for the most part, do any more professional education than the minimum they are required to keep their medical licenses, and certainly do not keep up with the latest medical and neuroscience research – of SSRIs to a large segment of the population (think about how many people you personally know who are on some form of antidepressant, as opposed to 10 or 15 years ago, when you hardly knew anybody who was taking them) is endangering the long-term neurological health of a lot of people.
And that should be unacceptable to you and me.
In the end, each of is responsible for our own health and well-being.
While medical professionals have value and can provide some insight, guidance, and, most importantly, acute care when needed, we should be doing our homework and advocating for our best physical and neurological health – and, even more critically, for our loved ones with dementias and Alzheimer’s Disease who are depending on us to advocate for them and in their best interests at all times – in our medical care.
When we turn the full responsibility over to anyone else – even those in the medical profession – and blindly follow them and do what they say, without even knowing or understanding what it means for us, then we acting both ignorantly and foolishly.
None of us can afford to do that.
So, we are supposed to use SSRIs for anxiety, because benzodiazepines heighten dementia risk? O.k. so in my experience of 32 years as a physician, SSRIs work minimally if at all for anxiety, so I would be putting a patient at heightened risk for dementia with a drug that isn’t even effective for their anxiety. The risk benefit ratio isn’t worth it. Any honest doctor knows gabapentin, Lyrica, hydroxyzine, et al don’t work for anxiety either. That leaves only benzodiazepines, but at least they work! If I am discouraged from giving a benezodiazepine to an anxiety patient and don’t do so, they either wrap their car around a tree during a panic attack or self medicate with alcohol. Are these scenarios better than giving a benzodiazepine? Medicine today lacks common sense, lacks seeing the bigger picture. Further, many menopausal women in the 1950’s took diazepam. It wasn’t addictive back then. So why is it now addictive 70 years later? Does anyone see the logic in my argument here? The Harvard and University of London studies showing the relationship between benzodiazepines and dementia was funded by drug companies with new anti anxiety medications being developed in their R and D. Getting the picture? I am sick of being the cause of patients death from accidents during a panic attack because I am restricted from giving them the only drug that works. And for patient with life long anxiety, what is the addiction issue? They are always going to need the drug. Where has the common sense in medicine gone regarding anxiety treatment?. So many classes of medications are shown to cause dementia including statins and antibiotics. Why are we picking on benezodiazepines? Why are we were squelching our ability to treat the very common problem of anxiety, that 50 of my patients have? What is wrong with this picture? I hope anyone reading this sees the common sense here and realizes benezodiazepines are the only effective treatment for anxiety and takes it off the list of medications discouraged that we prescribe. Help me save the life of my patients. Please.
Dr. Nordan, I appreciate your comments and perspective. I think the key here is appropriate use of these medications, not the discontinuation of their use.
My mom needed, after she developed vascular dementia, Lewy Body dementia, and Alzheimer’s Disease, anti-anxiety medication to help with the anxiety symptoms of these neurological diseases. I, as her medical advocate, asked her doctor to prescribe a low-dose benezodiazepine that she took daily.
But until the dementias, my mom had never taken antidepressants or anti-anxiety medication of any kind, although she’d been through different statins through the years because her blood pressure was difficult to control, so that very well could have been a contributor to her dementias.
While you seem to take a moderate approach – and I commend you for that – to prescribing antidepressants and anti-anxiety medication to your patients, it is my observation that many physicians are overprescribing these to anyone who walks in and says they need them, as sort of a cure-all for what are, in reality, the normal ups and downs of life that we go through in our time here on this planet. In times past, people used times of adversity to learn, to grow, and the change (I am not discounting real depression that is related to brain chemistry and DNA or PTSD-type anxiety and panic, in which medication is PART of the therapeutic approach, but not the ONLY approach).
Now many people who are confronted with the challenges we face because we’re human and because we’re alive numb themselves, with a majority in the medical community facilitating this, instead of facing it and coming out better for it on the other side.
And that’s misuse of these classes of drugs and it is potentially a factor in these people developing dementia in the future.
There is no single cause of dementia, as you are well aware. We don’t even know enough about dementias to really understand all the underlying things that come together in these diseases. But this blog highlights possible factors that neuroscience research has highlighted as contributors to try to give readers as much information as is currently available.
Again, thank you for your input. I seek moderation and all sides of the story when I write the articles for this blog, and you’ve contributed to that.
I stumbled across this website by accident and found this particular article of interest. I’m 65, had a lot of major life changes which hit home all at once beginning just around the time Covid hit. i was worse for wear with the changes and Dr. prescribed lexapro: she interpreted my problems as depression related and also gave me hydroxyzine for panic attacks. My issues weren’t depression related and I never had a good experience on antidepressants in the distant past. Well before starting a new job recently I started the lexapro. I figured let me see if the problems ARE in fact with me, was it my aging personality, or just the adjustment to another change…. On the 9th day into taking 5mg daily i developed jitters, 3 nights of no sleep and then into a manic panic attack. I quit my job after the 3rd night of not sleeping-I was in such a state of panic. Nothing specific was in my mind that should have caused me to panic or get manic: I’ve never had a manic attack…but the fact I hadn’t slept for 3 nights, and had very little nourishment during those days as well…put me over the edge. My Doc didn’t return my call for 4 days, i needed to know how to wean off these mad pills. finally spoke to my daughter, she’s an RN -she recommended i stop taking lexapro and the hydroxyzine immediately since i wasn’t on them all that long. 2 days later I was my old self again. 4 days on my doctor finally called me. she was bogged down after being out for a week with covid…yadayadayada. Umm
what about me and the fact that I was taking these meds that SHE prescribed and bouncing off the walls? why didn’t another doctor from the ‘group’ call me to guide me on weaning off? I was manic already and then became fearful of what would or could happen if i just stopped these drugs. So, I’m now out of a job due to having that episode and not being able to manage it -should have just called out sick but i just was not thinking straight after 3 nights of no sleep and little nourishment…I had no real appetite while taking the lexapro. I’ve started meditating now instead of the meds, it’s helping me get a more solid sleep and I’m praying it for success in getting this job tomorrow. As you stated in your comments – there are people who need those types of meds ~but they are definitely not geared for everyone…and not a cure-all.
Thank you, Kat, for taking the time to comment. What happened to you – with the random cocktail of medications – is not uncommon. Your doctor’s medical knowledge is current as of the day she graduated medical school. That’s not necessarily her fault because there is simply too much new knowledge for doctors to keep up with. The other problem is that doctors are now like lawyers: they’re expected to make money for the practice and that means less time with patients and less listening. The combination can be what you experienced. One of the things that I recommend to people over 60 is that they find a geriatric doctor for their PCP. As the body ages, medications that may work well in younger people can wreak havoc in older people because metabolism in the brain and the body changes with age. I’m glad your daughter was able to help you, but I’m very sorry you went through this. I pray for success with your new job opportunity and hope that you don’t experience anything like this again. Take care, my friend.