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BMJ 2011; 343 doi: (Published 27 July 2011) Cite this as: BMJ 2011;343:d4746

Antidepressants don’t work for older people with depression and dementia

Doctors should think carefully before prescribing antidepressants to depressed adults with Alzheimer’s disease, say researchers from the UK, after a landmark trial reported that the two most widely prescribed agents worked no better than placebo. Sertraline and mirtazapine did not reduce depression scores for older people referred to psychiatric services with dementia and depression, and they had no lasting impact on more than a dozen secondary outcome measures, including quality of life for patients or carers. Both drugs caused significantly more side effects than the placebo.

All three groups of patients improved during the first 13 weeks of the trial. The researchers are confident that improvements had little to do with either drug treatment but more to do with the usual care given to all participants by specialist psychiatric services for older people. Usual care depended on local protocols, but it would have included a variety of supportive and problem solving strategies in the first instance.

The 326 participants had a mean age of 80, moderately severe Alzheimer’s disease, and clinically important depression, often for more than six months. The researchers and a linked comment (doi:10.1016/S0140-6736(11)61031-3) agree that an antidepressant now looks like the wrong first line choice for the many patients with similar profiles. Adults at risk of suicide were excluded from this placebo controlled trial.

Rural isolation is linked to higher mortality from COPD


In a cohort of 26 591 men admitted to US hospitals with an exacerbation of chronic obstructive pulmonary disease (COPD), those living in isolated rural areas were significantly more likely to die than those living in more urban areas (5.0% v 3.8%; adjusted odds ratio 1.42, 95% CI 1.07 to 1.89).

All were admitted to hospitals managed by the Veterans Affairs Administration, which provides patient care to …

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