Monday, August 21, 2023

SSRIs May Increase Risks Associated With Anti-Amyloid Alzheimer's Medications

Doctors should be careful about prescribing anti-amyloid medications to patients with Alzheimer’s disease who are taking antidepressants, caution the authors of a letter published in Alzheimer’s & Dementia.

Despite the recent buzz around the U.S. Food and Drug Administration’s approval of multiple anti-amyloid medications for the treatment of Alzheimer’s disease, it is well known that these drugs come with some risks, including internal swelling and bleeding in the brain. Several selective serotonin reuptake inhibitors (SSRIs) also increase the risk of internal bleeding, and as depression is common among people with dementia, it is possible that patients eligible for anti-amyloid therapy will be taking SSRIs.

“Drugs with the highest degree of serotonin reuptake inhibition, such as fluoxetine, sertraline, and paroxetine, are frequently associated with increased bleeding and modifications of hemostasis markers that require special attention in the era of the anti-amyloid drugs,” wrote Beatriz Pozuelo Moyano, M.D., of Lausanne University Hospital in Switzerland and colleagues.

In addition to evaluating patients eligible for anti-amyloid therapy for prior history of microhemorrhages, physicians may benefit from considering the following questions:

  • What type of antidepressant is the patient taking? Tricyclic antidepressants, serotonin antagonist and reuptake inhibitors (such as trazodone), or some of the norepinephrine reuptake inhibitors (such as atomoxetine or bupropion) are associated with a lower risk of hemorrhage than SSRIs.
  • How long has the patient has been taking antidepressants? The risk of intracerebral hemorrhage is greatest during the first 30 days a patient is taking SSRIs.
  • Could the patient be switched to a nonpharmacological intervention? Treating patients with behavioral and psychological symptoms of dementia with nonpharmacological interventions is always preferred.

“[W]e estimate that in patients eligible for anti-amyloid drugs, the indication for antidepressant treatment and its dose should be periodically reevaluated as the antiplatelet effect in antidepressants is dose dependent,” Moyano and colleagues wrote.

To read more on this topic, see the Psychiatric News article “FDA Approves Second Antibody Therapy for Alzheimer’s.”

(Image: iStock/nortonrsx)

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