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Sertraline and mirtazapine do not reduce severity of depression in people with dementia

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Are the two most commonly prescribed drugs for depression in dementia (sertraline and mirtazapine) efficacious and safe compared with placebo?


326 adults with probable or possible Alzheimer's disease (National Institute of Neurological and Communicative Diseases and Stroke – Alzheimer's Disease and Related Disorders Association criteria) and depression which lasted for ≥4 weeks and was assessed as potentially needing antidepressants by the referring psychiatrist. Participants also had to score ≥8 on the Cornell scale for depression in dementia (CSDD). The inclusion criteria were selected to reflect clinical practice. Individuals were excluded if they were clinically critical (eg, suicide risk), had contraindications to study drugs, were already on antidepressants or were without a carer.


Old-age psychiatry services in nine UK National Health Service (NHS) clinical centres in England; from January 2007 to October 2010.


Sertraline (target dose 150 mg per day), mirtazapine (target dose 45 mg per day) or placebo (control). Participants began with one tablet (sertraline 50 mg, mirtazapine 15 mg or placebo), and the dose was increased to two tablets at week 2. At week 4, each participant undertook CSDD assessment and if their score was ≥4 the dose was increased to three tablets; and …

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  • Sources of funding The UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme.


  • Competing interests None.

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