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Depressive symptoms, antidepressant use, and future cognitive health in postmenopausal women: the Women's Health Initiative Memory Study

Published online by Cambridge University Press:  03 February 2012

Joseph S. Goveas ,
Patricia E. Hogan ,
Jane M. Kotchen ,
Jordan W. Smoller ,
Natalie L. Denburg ,
JoAnn E. Manson ,
Aruna Tummala ,
W. Jerry Mysiw ,
Judith K. Ockene  and
Nancy F. Woods
...Show all authors
Joseph S. Goveas*
Affiliation:
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Patricia E. Hogan
Affiliation:
Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Jane M. Kotchen
Affiliation:
Department of Population Health, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Jordan W. Smoller
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
Natalie L. Denburg
Affiliation:
Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa, USA
JoAnn E. Manson
Affiliation:
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Aruna Tummala
Affiliation:
Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
W. Jerry Mysiw
Affiliation:
Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, Ohio, USA
Judith K. Ockene
Affiliation:
Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Nancy F. Woods
Affiliation:
Family and Child Nursing, University of Washington, Seattle, Washington, USA
Mark A. Espeland
Affiliation:
Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Sylvia Wassertheil-Smoller
Affiliation:
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
*
Correspondence should be addressed to: Joseph S. Goveas, MD, Assistant Professor, Department of Psychiatry and Behavioral Medicine Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226. Phone: +414-955-8983; Fax: +414-955-6299. Email: jgoveas@mcw.edu.
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Abstract

Background: Antidepressants are commonly prescribed medications in the elderly, but their relationship with incident mild cognitive impairment (MCI) and probable dementia is unknown.

Methods: The study cohort included 6,998 cognitively healthy, postmenopausal women, aged 65–79 years, who were enrolled in a hormone therapy clinical trial and had baseline depressive symptoms and antidepressant use history assessments at enrollment, and at least one postbaseline cognitive measurement. Participants were followed annually and the follow-up averaged 7.5 years for MCI and probable dementia outcomes. A central adjudication committee classified the presence of MCI and probable dementia based on extensive neuropsychiatric examination.

Results: Three hundred and eighty-three (5%) women were on antidepressants at baseline. Antidepressant use was associated with a 70% increased risk of MCI, after controlling for potential covariates including the degree of depressive symptom severity. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) were both associated with MCI (SSRIs: hazard ratios (HR), 1.78 [95% CI, 1.01–3.13]; TCAs: HR, 1.78 [95% CI, 0.99–3.21]). Depressed users (HR, 2.44 [95% CI, 1.24–4.80]), non-depressed users (HR, 1.79 [95% CI, 1.13–2.85]), and depressed non-users (HR, 1.62 [95% CI, 1.13–2.32]) had increased risk of incident MCI. Similarly, all three groups had increased risk of either MCI or dementia, relative to the control cohort.

Conclusions: Antidepressant use and different levels of depression severity were associated with subsequent cognitive impairment in a large cohort of postmenopausal women. Future research should examine the role of antidepressants in the depression–dementia relationship and determine if antidepressants can prevent incident MCI and dementia in individuals with late-life depression subtypes with different levels of severity.

Keywords

antidepressantsselective serotonin reuptake inhibitorslate-life depressioncognitive declinemild cognitive impairmentdementia
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Special Issue 8: Focus on late life depression , August 2012 , pp. 1252 - 1264
Copyright
Copyright © International Psychogeriatric Association 2012

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Supplementary material: File

Goveas Supplementary Table

SUPPLEMENTAL TABLE. Scores on modified CERAD measures for MCI, Probable dementia, MCI/Probable dementia, Median (Min-Max).

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