Comparison of Sertraline, Venlafaxine and Desipramine Effects on Depression, Cognition and the Daily Living Activities in Alzheimer Patients

N. Mokhber; E. Abdollahian; A. Soltanifar; R. Samadi; A. Saghebi; M. B. Haghighi; A. Azarpazhooh

doi:10.1055/s-0034-1377041

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2014; 47(04/05): 131-140
DOI: 10.1055/s-0034-1377041

Original Paper

Comparison of Sertraline, Venlafaxine and Desipramine Effects on Depression, Cognition and the Daily Living Activities in Alzheimer Patients

N. Mokhber

¹Psychiatry and Behavioral Sciences Research Center, lbn-e-Sina Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

,

E. Abdollahian

¹Psychiatry and Behavioral Sciences Research Center, lbn-e-Sina Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

,

A. Soltanifar

¹Psychiatry and Behavioral Sciences Research Center, lbn-e-Sina Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

,

R. Samadi

¹Psychiatry and Behavioral Sciences Research Center, lbn-e-Sina Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

,

A. Saghebi

²General Practice, Mashhad, Iran

,

M. B. Haghighi

²General Practice, Mashhad, Iran

,

A. Azarpazhooh

³Faculty of Dentistry, Institute of Health Policy, Management and Evaluation of Faculty of Medicine, University of Toronto, Toronto, Canada

› Author Affiliations

Abstract

Rationale: The effects of antidepressants on mood, cognition and the daily activities of Alzheimer patients are ambiguous. The effects of antidepressants SSRIs (serotonin specific reuptake inhibitors), TCAs (tricyclic antidepressants) and SNRIs (serotonin-norepinephrine reuptake inhibitors), in particular, are unknown.

Objectives: This study aimed to compare the effects of sertraline, venlafaxine and desipramine on depression, cognition and the daily activities of Alzheimer patients.

Methods: This randomized double-blind trial was approved by the Research and Ethics Committees of Mashhad University of Medical Sciences. 59 moderate Alzheimer patients with major depressive disorder were randomly divided into 3 groups (sertraline, venlafaxine and desipramine), treated for 12 weeks (150 mg maximum dose) and assessed by the Hamilton Depression Test (HRSD), the Mini Mental State Examination (MMSE) and the Barthel index at the week 0 and the 2^nd, 4^th, 8^th, 12^th weeks thereafter. Data were analyzed by SPSS software, using ANOVA and paired t-tests.

Results: In the sertraline group, the results of all 3 tests, HRSD, MMSE and Barthel, in the 12^th week showed significant improvements in comparison to the baseline (P<0.05 in all 3 tests). In the venlafaxine group, the results of MMSE and Barthel revealed significant improvements (P<0.05 in both tests). In the desipramine group, there was a significant improvement only in the Barthel test at the 12^th week (P<0.05).

Conclusion: In this trial, sertraline treatment was associated with superior effectiveness in relation to depressive, cognitive, and behavioral symptoms.

Key words

Alzheimer’s disease (AD) - antidepressants - dementia - cognition - depression

Full Text

References

References
1 Lopes MA, Hototian SR, Bustamante SE et al. Prevalence of cognitive and functional impairment in a community sample in Ribeirao Preto, Brazil. Int J Geriatr Psychiatry 2006; 22: 770-776
2 Low LF, Brodaty H, Edwards R et al. The prevalence of “cognitive impairment no dementia” in community-dwelling elderly: a pilot study. Aust N Z J Psychiatry 2004; 38: 725-731
3 Zuidema SU, de Jonghe JF, Verhey FR et al. Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the dutch nursing home version of the neuropsychiatric inventory in different stages of dementia. Geriatr Cogn Disord Dement 2007; 24: 169-176
4 Andrieu S, Rive B, Guilhaume C et al. New assessment of dependency in demented patients: impact on the quality of life in informal caregivers. Psychiatry Clin Neurosci 2007; 61: 234-242
5 Conn D, Thorpe L. Assessment of behavioural and psychological symptoms associated with dementia. Can J Neurol Sci 2007; 34 (Suppl. 01) 67-71
6 Bélicard-Pernot C, Manckoundia P, Ponavoy E et al. Antidepressant use in demented elderly subjects: current data. Rev Med Interne 2009; 30: 947-754 [article in French]
7 Berger AK, Fratiglioni L, Winblad B et al. Alzheimer’s disease and depression: preclinical comorbidity effects on cognitive functioning. Cortex 2005; 41: 603-612
8 Modrego PJ. Depression in Alzheimer’s disease. Pathophysiology, diagnosis, and treatment. J Alzheimers Dis 2010; 21: 1077-1087
9 Lyketsos CG, DelCampo L, Steinberg M et al. Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry 2003; 60: 737-746
10 Thompson S, Herrmann N, Rapoport MJ et al. Efficacy and safety of antidepressants for treatment of depression in Alzheimer’s disease: a metaanalysis. Can J Psychiatry 2007; 52: 248-255
11 Moretti R, Torre P, Antonello RM et al. Depression and Alzheimer’s disease: symptom or comorbidity?. Am J Alzheimers Dis Other Demen 2002; 17: 338-344
12 Bassiony MM, Warren A, Rosenblatt A et al. The relationship between delusions and depression in Alzheimer’s disease. Int J Geriatr Psychiatry 2002; 17: 549-556
13 Espiritu DA, Rashid H, Mast BT et al. Depression, cognitive impairment and function in Alzheimer’s disease. Int J Geriatr Psychiatry 2001; 16: 1098-1103
14 Mahoney R, Regan C, Katona C et al. Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. Am J Geriatr Psychiatry 2005; 13: 795-801
15 Crow TJ, Cross AJ, Cooper SJ et al. Neurotransmitter receptors and monoamine metabolites in the brains of patients with Alzheimer-type dementia and depression, and suicides. Neuropharmacology 1984; 23: 1561-1569
16 Espiritu DA, Rashid H, Mast BT et al. Depression, cognitive impairment and function in Alzheimer’s disease. Int J Geriatr Psychiatry 2001; 16: 1098-1103
17 Starkstein SE, Mizrahi R, Power BD. Depression in Alzheimer’s disease: phenomenology, clinical correlates and treatment. Int Rev Psychiatry 2008; 20: 382-388
18 Kaup BA, Loreck D, Gruber-Baldini AL et al. Depression and its relationship to function and medical status, by dementia status, in nursing home admissions. Am J Geriatr Psychiatry 2007; 15: 438-442
19 Cannon-Spoor HE, Levy JA, Zubenko GS et al. Effects of previous major depressive illness on cognition in Alzheimer disease patients. Am J Geriatr Psychiatry 2005; 13: 312-318
20 de Vasconcelos Cunha UG, Lopes Rocha F, Avila de Melo R et al. A placebo-controlled double-blind randomized study of venlafaxine in the treatment of depression in dementia. Dement Geriatr Cogn Disord 2007; 24: 36-41
21 Kessing LV, Harhoff M, Andersen PK. Treatment with antidepressants in patients with dementia – a nationwide register-based study. Int Psychogeriatr 2006; 19: 902-913
22 Devanand DP, Pelton GH, Marston K et al. Sertraline treatment of elderly patients with depression and cognitive impairment. Int J Geriatr Psychiatry 2003; 18: 123-130
23 Magai C, Kennedy G, Cohen CI et al. A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer’s disease. Am J Geriatr Psychiatry 2000; 8: 66-74
24 Lebert F. Serotonin reuptake inhibitors in depression of Alzheimer’s disease and other dementias. Presse Med 2003; 32: 1181-1186 [article in French]
25 Petrovic M, De Paepe P, Van Bortel L. Pharmacotherapy of depression in old age. Acta Clin Belg 2005; 60: 150-156
26 Edwards JG, Anderson I. Systematic review and guide to selection of selective serotonin reuptake inhibitors. Drugs 1999; 57: 507-533
27 Clarfield AM. Review: Sedative hypnotics increase adverse effects more than they improve sleep quality in older persons with insomnia. Evid Based Med 2006; 11: 110
28 Nair NP, Amin M, Schwartz G et al. A comparison of the cardiac safety and therapeutic efficacy of trimipramine versus doxepin in geriatric depressed patients. J Am Geriatr Soc 1993; 41: 863-867
29 Gareri P, De Fazio P, Cotroneo A et al. Anticholinergic drug-induced delirium in an elderly Alzheimer’s dementia patient. Arch Gerontol Geriatr 2007; 44 (Suppl. 01) 199-206
30 Lazarus LW, Davis JM, Dysken MW. Geriatric depression: a guide to successful therapy. Geriatrics 1985; 40: 43
31 Lin HY, Yeh WL, Huang BR et al. Desipramine protects neuronal cell death and induces heme oxygenase-1 expression in Mes23.5 dopaminergic neurons. PLoS One 2012; 7
32 Sadock BJ, Sadock VA. Kaplan & Sadock’s comprehensive textbook of psychiatry. 9^th ed. Philadelphia: Lippincott Williams & Wilkins; 2009: 2965-3334 3932–4258
33 Dording CM, Mischoulon D, Petersen TJ et al. The pharmacologic management of SSRI-induced side effects: a survey of psychiatrists. Ann Clin Psychiatry 2002; 14: 143-147
34 Banerjee S, Hellier J, Dewey M et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 2011; 378 (9789) 403-411
35 Ancill RJ, Holliday SG. Treatment of depression in the elderly: a Canadian view. Prog Neuropsychopharmacol Biol Psychiatry 1990; 14: 655-661
36 Barkin RL. Sertraline and mirtazapine do not reduce severity of depression in people with dementia. Evid Based Ment Health 2012; 15: 17
37 Alzheimer’s or depression: Could it be both? Alzheimer’s disease with depression is different 2010 available at http://www.mayoclinic.com/health/alzheimers/HQ00212/NSECTIONGROUP=2 accessed Dec. 10, 2010
38 Barber R, Baldwin R. Recognition of depression in primary care, which antidepressant?. IPA Bulletin Recent Advances 2010; 26
39 Blazer DG. Depression in Late Life: Review and Commentary. American Psychiatric Association 2009; 7: 118-136
40 Kennedy GJ. The sequenced treatment alternatives to relieve depression studies: how applicable are the results for older adults?. Primary Psychiatry 2006; 13: 33-36
41 Doraiswamy PM, Krishnan KR, Oxman T et al. Does antidepressant therapy improve cognition in elderly depressed patients?. J Gerontol A Biol Sci Med Sci 2003; 58: M1137-M1144
42 Munro CA, Longmire CF, Drye LT et al. Cognitive outcomes after sertaline treatment in patients with depression of Alzheimer disease. Am J Geriatr Psychiatry 2012; [Epub ahead of print]
43 Avila R, Bottino CM, Carvalho IA et al. Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer’s disease: a pilot study. Braz J Med Biol Res 2004; 37: 1721-1729
44 Foroughan M, Jafari Z, Shirin Bayan P. Finding norms in mini cognitive status examination of elderly people in Tehran, 2006. Cogn Sci News 2008; 38: 29-37 [in Persian]
45 Maleki M, Javidi Z, Kiafar B et al. Depression in vitiligo patients. Q J Fundamentals Mental Health 2005; 5-11 [in Persian]
46 Gharaei B. Reviews some of the cognitive pattern in patients with comorbid anxiety and depression. Master thesis in clinical psychology. Tehran Psychiatric Institute 1993;
47 McDowell I, Newell C. Measuring Health. A Guide to Rating Scales and Questionnaires. 2^nd ed. New York: Oxford University Press; 1996
48 Duncan PW, Samsa G, Weinberger M et al. Health status of individuals with mild stroke. Stroke 1997; 28: 740-745
49 Roberts L, Counsell R. Assessment of clinical outcomes in acute stroke trials. Stroke 1998; 28: 986-991
50 Mahoney F, Barthel D. Functional evaluation: the Barthel Index. Md Med J 1965; 14: 61-65 PMID 14258950
51 Saeed Shah Hosseini S, Taghdisi H, Rahgozar M et al. Association between Barthel Index scores at admission and discharge clinical outcomes in elderly patients. Elderly (aged Iranian Journal) 1988; 60-65
52 Gellis ZD, McClive-Reed KP, Brown E. Treatments for depression in older persons with dementia. Ann Longterm Care 2009; 17: 29-36
53 Fischer CE, Schweizer TA, Joy J et al. Determining the impact of dementia on antidepressant treatment response in older adults. J Neuropsychiatry Clin Neurosci 2011; 23: 358-361
54 Munro CA, Brandt J, Sheppard JM et al. Cognitive response to pharmacological treatment for depression in Alzheimer disease: secondary outcomes from the depression in Alzheimer’s disease study (DIADS). Am J Geriatr Psychiatry. 2004 12. 491-498
55 Rozzini L, Chilovi BV, Conti M et al. Efficacy of SSRIs on cognition of Alzheimer’s disease patients treated with cholinesterase inhibitors. Int Psychogeriatr 2010; 22: 114-119
56 Nowakowska E, Kus K, Florek E et al. The influence of tobacco smoke and nicotine on antidepressant and memory-improving effects of venlafaxine. Hum Exp Toxicol 2006; 25: 199-209
57 Staab JP, Evans DL. Efficacy of venlafaxine in geriatric depression. Depress Anxiety 2000; 12 (Suppl. 01) 63-68
58 Bor A, Matuz M, Doró P et al. Drug-related problems in the elderly. Orv Hetil 2012; 153: 1926-1936 [article in Hungarian]
59 Hansten PD. Overview of the safety profile of the H2-receptor antagonists. DICP 1990; 24 (11 Suppl) S38-S41
60 Zhou SF. Polymorphism of human cytochrome P450 2D6 and its clinical significance: Part I. Clin Pharmacokinet 2009; 48: 689-723
61 Uher R, Perlis RH, Henigsberg N et al. Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms. Psychol Med 2012; 42: 967-980
62 Bragin V, Chemodanova M, Dzhafarova N et al. Integrated treatment approach improves cognitive function in demented and clinically depressed patients. Am J Alzheimers Dis Other Demen 2005; 20: 21-26