Study Suggests Paroxetine Does Not Pose Higher Risk of Dementia Than Other SSRIs

Previous studies suggest anticholinergic medication use is associated with an increased risk of cognitive decline and dementia. However, a study published in Psychiatric Services in Advance now reports that the highly anticholinergic SSRI paroxetine does not appear to increase the risk of dementia among elderly nursing home residents with depression compared with other SSRIs.

To evaluate the risk of dementia associated with use of paroxetine versus other SSRIs among elderly patients with depression, researchers from the University of Houston and the University of Iowa performed a retrospective cohort study using propensity score matching with 2007–2010 Minimum Data Set–Linked Medicare data.

Subjects included elderly nursing home patients with depression who were new users of SSRIs, and they were followed for a maximum of two years. The primary outcome measured was time to diagnosis of dementia after initiation of either paroxetine or other SSRIs (sertraline, citalopram, fluoxetine, fluvoxamine, and escitalopram).

Based on the statistical analysis of 3,796 patients (n=1,898 in each group), the researchers found the incidence of dementia was 7.5% for users of paroxetine and 8.6% for users of other SSRIs—a nonsignificant difference.

“Although paroxetine has stronger anticholinergic properties compared with other SSRIs, the current study suggests that pharmacological differences between paroxetine and other SSRIs do not translate into significant differences with respect to risk of dementia,” the study authors noted. “Given the frequent use of paroxetine, there is a need for future studies to better understand differences in short-term cognitive effects and long-term dementia risk associated with the use of paroxetine and other SSRIs among elderly persons with depression.”

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