The December edition of ‘Eyes on Evidence’, the free monthly e-bulletin from NHS Evidence’covering major new evidence as it emerges with an explanation about what it means for current practice, includes an expert commentary on new data from the ‘Health Technology Assessment Study of the Use of Antidepressants for Depression in Dementia’ (HTA-SADD) trial that assessed the efficacy and safety of sertraline and mirtazapine to treat depression in people with dementia, compared with placebo. The study reported decreases in depression scores at 13 weeks which did not differ between the groups, a finding that persisted to 39 weeks. Fewer controls had adverse reactions (26%) than did participants in the sertraline group (43%) or mirtazapine group (41%). The researchers suggest that because the two antidepressants were no more effective than placebo and had an increased risk of adverse events, their routine use to treat depression in people with dementia should be reconsidered.

According to the expert commentary "Depression is a common manifestation of behavioural and psychological symptoms of dementia (BPSD) with the two disorders having a multiplicative effect. Depression in dementia is complicated by difficulties in detection and diagnosis; many of the symptoms in the two disorders overlap, with one often being mistaken for the other. Much is still unknown with regards to the complex biological and psychological relationship between the two conditions. This trial adds to a growing body of evidence suggesting that antidepressants have only limited, if any, effect on depression in dementia. A recent systematic review found similar results. Treating depression in dementia is complex and most evidence points to the need for specialist input. This study is unlikely to stop the use of antidepressants in people with dementia, and nor should it, but it may lead to a more sanguine approach to dealing with BPSD. Antidepressants may be effective in some patients and they should remain a therapeutic option, although perhaps used with more caution than previously. Whilst the findings here are negative, they nonetheless constitute another important step forward in high-quality evidence-based dementia care."

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