Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study

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Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Antidepressants and Dementia Risk: A Tale of Two Therapies (But Only Two Years of Follow-Up)

This retrospective cohort study found that older adults with depression taking SSRIs/SNRIs may have a modestly increased risk of developing dementia within two years compared to those receiving psychotherapy. However, the short follow-up period, observational design, and potential for confounding limit the strength of the causal inference.

Possible Conflicts of Interest

None identified

Identified Weaknesses

Limited follow-up duration

The study relies on the MEPS dataset, which has a limited follow-up period of two years. Dementia development can take longer, potentially underestimating the risk.

Observational design

The observational nature of the study makes it difficult to definitively establish cause-and-effect. Other factors could contribute to the observed association.

Potential for residual confounding

Although the researchers attempted to control for confounders, it is still possible that unmeasured factors (e.g., genetic predisposition, lifestyle) influenced the results.

Depletion of susceptibles

The analysis could not account for the 'depletion of susceptibles'—individuals already at lower risk of dementia may be more likely to use SSRIs/SNRIs, skewing the results.

Lack of dose and duration information

The study does not include data on the dosage and duration of SSRI/SNRI use, which could be important factors in dementia risk.

Rating Explanation

This is a retrospective cohort study using a large dataset, which is a strength. However, the limited follow-up duration, observational design, and potential for residual confounding are notable limitations that lower the rating. The findings are interesting but not definitive due to these weaknesses.

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