Efficacy And Safety Of Antidepressants For Behavioraland Psychological Symptoms In Dementia Patients: A Systematic Review And Meta-analysis

Background:Although the drug therapy of behavioral and psychological symptoms in dementia(BPSD)patients is widely used,there are still many controversies about the efficacy and safety of drug therapy.In recent years,more and more studies have found that antidepressant can improve BPSD,but its efficacy and safety for behavioral and psychological symptoms in dementia patients is unknown.Objectives:We made a systematic review and meta-analysis to assess the efficacy and safety of antidepressants in treating behavioral and psychological symptoms in dementia patients.Methods:We searched the CINAHL,the Cochrane Library,EMBASE,Pubmed,Psycinfo,Web of Science and other databases from database inception until July,2020.We only included randomized controlled trials which compared antidepressants to placebo for treatment in dementia patients.Patients with depression diagnosis were excluded.The efficacy and safety of different antidepressants were compared to placebo.We collected information on efficacy as measured bythe pooling of standardized mean differences(SMDs)calculated from the reduction in mean neuropsychiatric symptom rating scales scores and safety as measured by dropouts for all reasons.Result:A total of 7 articles(472 individuals)met our inclusion criteria and were included.For main outcome,antidepressants could decrease general behavioral and psychological symptoms in non-depressive dementia patients(SMD–0.31,95%CI–0.51 to–0.11,p=0.002).For secondary outcome,antidepressants alleviated patients’psychosis(SMD–0.73,95%CI–1.2 to–0.26,p=0.002).But,antidepressants aggravated cognitive deficit(MD–1.56,95%CI–2.51 to–0.6,p=0.001). Antidepressants didn’t improve symptom of agitation(SMD–0.23,95%CI–0.65 to–0.19,p=0.29).As for safety,there were no statistic differences between antidepressants and placebo in withdrawal due to any cause(RR1.05,95%CI 0.78 to 1.42,I~2=0%,p=0.76)and dropout due to adverse effects(RR 0.84,95%CI 0.48 to 1.46,I~2=0%,p=0.53).Conclusions:In dementia patients,antidepressants could alleviate general neuropsychiatric and behavioral symptoms.Nevertheless, antidepressants didn’t improve agitation in these patients.Worse,antidepressants may aggravate patients’cognitive impairment.As for safety,antidepressants are tolerable in dementia patients.