Dementia has no cure. That makes prevention, or even delaying the progression, critical. One area researchers are still untangling is whether long-term antidepressant use may increase the risk of developing dementia. So far, the answer is not clear-cut.
How antidepressants work
Antidepressants are prescribed to manage depression, anxiety, and other mood disorders. The most common types include SSRIs (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), and tricyclic antidepressants. These drugs affect brain chemicals like serotonin and norepinephrine, which influence mood, focus, and emotional regulation.
However, some antidepressants also have anticholinergic effects. That means they interfere with acetylcholine, a neurotransmitter that plays a key role in learning and memory. Others may affect inflammation or interact with processes that influence brain cell growth or loss. These overlapping effects raise legitimate questions about whether certain medications might also impact cognitive decline, especially when used over long periods.
What the research says
Some studies have found a potential link between long-term antidepressant use and an increased risk of dementia, especially in older adults. Medications with stronger anticholinergic effects, such as certain tricyclics or first-generation antihistamines, may carry higher risk.
However, not all research agrees. Many studies point to depression itself as a risk factor for dementia. In that case, the concern may not be the medication, but rather the underlying condition it is prescribed to treat. People with depression are already more vulnerable to cognitive changes, which complicates efforts to isolate the effects of the medication.
What makes the research so complicated?
This isn’t a simple cause-and-effect issue. Many people who take antidepressants already have other risk factors for dementia, including sleep issues, social isolation, inflammation, or chronic illness. Some may even be in early stages of cognitive decline before starting medication.
Without randomized long-term trials, it’s difficult to say whether antidepressants directly increase risk, or whether they are more commonly prescribed in people who are already at higher risk.
What should you watch for?
If you or someone you care about is taking antidepressants, particularly later in life, it’s important to:
Review the medication list regularly with a physician or pharmacist
Look out for medications with high anticholinergic effects
Monitor for new or worsening memory issues after medication changes
Avoid polypharmacy where possible (taking multiple medications that affect the same systems)
This doesn’t mean avoiding antidepressants altogether. For many people, these medications improve quality of life and prevent serious outcomes related to untreated depression. It just means weighing benefits against potential risks.
What providers recommend
Work with your doctor to choose medications with lower anticholinergic burden when possible. Ask whether a taper or switch might be safe if the prescription is long-standing and no longer clearly needed. For those with existing cognitive concerns, this review becomes even more important.
Final thought
Dementia and depression often overlap, but they are not the same. If you’re managing one, stay alert to the signs of the other. And don’t hesitate to ask tough questions about long-term prescriptions, especially if something no longer feels right.
References
- Boseley, S. (2018). Some antidepressants linked to dementia risk. www.theguardian.com/…/some-antidepressants-linked-to-dementia-risk
- Kapo, J. M. (2011). Dementia. https://doi.org/10.1016/B978-1-4377-1619-1.00032-9
- Mind. (2019). What are antidepressants? www.mind.org.uk/…/#.XSnCEo97lPZ
- Warner, T. T. (2009). Dementia. https://doi.org/10.1016/B978-0-7506-5410-4.00003-7
- Wang, Y.C. et al. (2018). Increased risk of dementia in patients with antidepressants: a meta-analysis of observational studies. https://doi.org/10.1155/2018/5315098
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