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Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort

  • Christophe Arbus (a1), Virginie Gardette (a2), Eric Bui (a1), Christelle Cantet (a2), Sandrine Andrieu (a2), Fati Nourhashémi (a2) (a3), Laurent Schmitt (a1), Bruno Vellas (a2) (a3) and the REAL.FR Group...


Background: Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription.

Methods: REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI).

Results: A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI ≥ 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression.

Conclusions: The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.


Corresponding author

Correspondence should be addressed to: Christophe Arbus, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, 31059 Toulouse, France. Phone: +33 561772351; Fax: +33 561777646. Email:


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Aalten, P., de Vugt, M. E., Jaspers, N., Jolles, J. and Verhey, F. R. (2005). The course of neuropsychiatric symptoms in dementia. Part I: Findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry, 20, 523530.
Arbus, C. et al. (2008). The prevalence of clinically significant depressive symptoms in Alzheimer's disease: relationship with other psychological and behavioral symptoms. International Journal of Geriatric Psychiatry, 23, 12091211.
Borson, S., Scanlan, J. M., Doane, K. and Gray, S. (2002). Antidepressant prescribing in nursing homes: is there a place for tricyclics? International Journal of Geriatric Psychiatry, 17, 11401145.
Burke, W. J., Dewan, V., Wengel, S. P., Roccaforte, W. H., Nadolny, G. C. and Folks, D. G. (1997). The use of selective serotonin reuptake inhibitors for depression and psychosis complicating dementia. International Journal of Geriatric Psychiatry, 12, 519525.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Gillette-Guyonnet, S. et al. (2003). The REAL.FR research program on Alzheimer's disease and its management: methods and preliminary results. Journal of Nutrition, Health and Aging, 7, 9196.
Gottfries, C. G., Karlsson, I. and Nyth, A. L. (1992). Treatment of depression in elderly patients with and without dementia disorders. International Journal of Clinical Psychopharmacology, 6 (Suppl. 5), 5564.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA, 185, 914919.
Lanctôt, K. L., Herrmann, N., Eryavec, G., van Reekum, R., Reed, K. and Naranjo, C. A. (2002). Central serotonergic activity is related to the aggressive behaviors of Alzheimer's disease. Neuropsychopharmacology, 27, 646654.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.
Lopez, O. L. et al. (2003). Patterns of change in the treatment of psychiatric symptoms in patients with probable Alzheimer's disease from 1983 to 2000. Journal of Neuropsychiatry and Clinical Neuroscience, 15, 6773.
Lyketsos, C. G., Breitner, J. C. and Rabins, P. V. (2001). An evidence-based proposal for the classification of neuropsychiatric disturbance in Alzheimer's disease. International Journal of Geriatric Psychiatry, 16, 10371042.
Margallo-Lana, M. et al. (2001). Prevalence and pharmacological management of behavioral and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 3944.
Meltzer, C. C. et al. (1998). Serotonin in aging, late-life depression, and Alzheimer's disease: the emerging role of functional imaging. Neuropsychopharmacology, 18, 407430.
Pollock, B. G. et al. (2002). Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. American Journal of Psychiatry, 159, 460465.
Rigler, S. K., Webb, M. J., Redford, L., Brown, E. F., Zhou, J. and Wallace, D. (2001). Weight outcomes among antidepressant users in nursing facilities. Journal of the American Geriatrics Society, 49, 4955.
Robert, P., Medecin, I. and Vincent, S. (1998). L'inventaire neuropsychiatrique: validation de la version française d'un instrument destiné à évaluer les troubles du comportement chez le sujet dément. L'Année Gérontologique, 5, 6386.
Rosen, W. G., Mohs, R. C. and Davis, K. L. (1984). A new rating scale for Alzheimer's disease. American Journal of Psychiatry, 141, 13561364.
Rosenberg, P. B., Mielke, M. M. and Lyketsos, C. G. (2005). Caregiver assessment of patients’ depression in Alzheimer disease: longitudinal analysis in a drug treatment study. American Journal of Geriatric Psychiatry, 13, 822826.
Salzman, C. et al. (2008). Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. Journal of Clinical Psychiatry, 69, 889898.
Schneider, L. S. et al. (2001). National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE): Alzheimer disease trial methodology. American Journal of Geriatric Psychiatry, 9, 346360.
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 15251538.
Selbaek, G., Kirkevold, O. and Engedal, K. (2008). The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes: a 12-month follow-up study. American Journal of Geriatric Psychiatry, 16, 528536.
Starkstein, S. E., Mizrahi, R. and Garau, L. (2005). Specificity of symptoms of depression in Alzheimer disease: a longitudinal analysis. American Journal of Geriatric Psychiatry, 13, 802807.
Steffens, D. C. et al. (2000). Prevalence of depression and its treatment in an elderly population: the Cache County Study. Archives of General Psychiatry, 57, 601607.
Thompson, S., Herrmann, N., Rapoport, M. J. and Lanctot, K. L. (2007). Efficacy and safety of antidepressants for treatment of depression in Alzheimer's disease: a metaanalysis. Canadian Journal of Psychiatry, 52, 248255.
Vellas, B. et al. (1999). The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition, 15, 116122.
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649655.


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Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort

  • Christophe Arbus (a1), Virginie Gardette (a2), Eric Bui (a1), Christelle Cantet (a2), Sandrine Andrieu (a2), Fati Nourhashémi (a2) (a3), Laurent Schmitt (a1), Bruno Vellas (a2) (a3) and the REAL.FR Group...


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