3.3 Treating late-life depression and cognitive impairment
Treating depression in the context of cognitive impairment can be challenging. In a study of recently remitted older adults with depression, donepezil and maintenance antidepressant therapy was compared to placebo and maintenance antidepressant therapy. The donepezil group temporarily improved global cognition and showed a lower rate of conversion to frank dementia, but was more likely to experience recurrent major depression compared with the placebo group. Therefore, the risk of increased recurrence of depression must be weighed against the benefit of reduced rate of dementia conversion when using cholinesterase inhibitor augmentation to treat LLD with mild cognitive impairment.
A meta-analysis investigated the efficacy of antidepressants for the treatment of depression in patients with both depression and dementia. Two of the seven studies in the meta-analysis found antidepressants to be more effective than placebo, the other five did not. It is still unclear whether antidepressants are effective in the treatment of depression in patients with dementia, but the weight of the evidence is that antidepressant pharmacotherapy in dementia does not “beat” placebo in terms of response rates.