Comparative Cognitive Profile of Second-Generation Antidepressants in Elderly Nursing Home Residents With Depression

Background: Past literature suggests that the use of second-generation antidepressants improves cognition in depressed elderly patients. Objective: This study assessed the comparative cognitive profile of commonly used second-generation antidepressant classes in elderly residents with depression. Methods: A multiple propensity score adjusted retrospective cohort study was conducted using 2007-2010 Medicare Part D claims and Minimum Data Set (MDS). Elderly nursing home residents (65 years or older) with depression using a new prescription of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tetracyclics constituted the study cohort. The outcome of interest was cognition, measured using the MDS Cognition Scale. Cognition was measured at each quarterly assessment after antidepressant initiation for a maximum of 1 year. The propensity score–adjusted repeated-measures mixed model was used to evaluate the comparative profile of SSRIs, SNRIs, and tetracyclics with respect to cognition. Results: The study cohort comprised 1518 elderly nursing home residents. Of these, 1081 received SSRIs (71.21%), 320 received tetracyclics (21.08%), and 117 received SNRIs (7.71%). The propensity score–adjusted repeated-measures mixed model did not show any statistically significant difference in cognition with the use of SSRIs (β = −0.14; 95% CI = −0.53, 0.25) or tetracyclics (β = −0.36; 95% CI = −0.80, 0.08) when compared with SNRIs, after controlling for other factors. Conclusions: The cognitive effect of SSRIs, SNRIs, and tetracyclics was similar in elderly nursing home residents with depression. Further studies are needed to evaluate the long-term cognitive effects of second-generation antidepressants in this vulnerable population.