Paroxetine may carry a higher dementia risk than other antidepressants for older people

In a recent publication in the Journal of the American Geriatrics Association, researchers have examined the possibility of an association between chronic antidepressant use and the development of dementia. Community‐dwelling older adults (> 64 years of age) without dementia were followed. SSRIs, TCAs and other antidepressants were examined. Paroxetine was considered separately to the other SSRIs because of intrinsic anticholinergic effects. Cumulative medication exposure was defined using total standardized daily doses and exposure in the most recent year was excluded to avoid use related to prodromal symptoms. The Cognitive Abilities Screening Instrument was administered every 2 years; low scores triggered clinical evaluation and consensus diagnosis procedures. Dementia risk was estimated according to medication use using Cox proportional hazards models. During a mean follow‐up of 7.7 years, 775 participants (25%) developed dementia; 659 (22%) developed possible or probable Alzheimer’s disease. Individual antidepressant classes were not associated with differences in dementia risk, although paroxetine use was associated with higher risk of dementia for all dosage exposures relative to no use, with the hazard ration as high as 2.13 (95% CI=1.32–3.43) at higher doses. The authors conclude that paroxetine and other anticholinergic antidepressants may be hazardous for older people.