Prescribing Antidepressants in Depressed Nursing Homes Residents with Dementia: Is it Evidence-based?

Depression and dementia are common comorbidities among Nursing Home (NH) residents. Antidepressants are widely used in this vulnerable population. However, the evidence for anti-depressant use, including from randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines, is inconsistent and conflicting. Additionally, antidepressants are associated with multiple adverse effects. Long-term care providers often need to deal with requests from patients' families, nursing staff, and colleagues to prescribe antidepressants, while following recommendations from pharmacists and regulations from the Center for Medicare and Medicaid Service (CMS) and Federal Drug Administration (FDA) not to prescribe or to discontinue antidepressants. It is difficult for long-term care providers to decide whether they should prescribe antidepressants and meet regulations and quality of care standards based on the few Randomized Controlled Trials (RCTs). A large randomized control study to examine the efficacy of antidepressants among depressed NH residents with dementia is urgently needed. We propose a practical step-wise approach to prescribe antidepressants for this vulnerable population.