I've been on Lexapro for several years now. I see no reason to think my mind is going to mush more quickly because of this. There's also the extreme way of looking at it like this. No SSRI at my current age could have led to self harm as bad as suicide. SSRI would at least help me live a life long enough to dementia, which would likely be decades. Based on that over-dramatic reasoning, I'll stick with the Lexapro.
I would love to see a similar detailed look at the evidence for dementia development in the setting of long-term benzodiazepine use. I might be wrong, but my feeling is also that it is not so straight forward, especially when you realise that dementia may affect sleep quality. So did the medicine cause the dementia, or did pre-clinical dementia lead to increased benzodiazepine use, say as a sleep aid?
It is disconcerting to find that the FDA allows manufacturers to submit clinical trials data on SSRI/SNRI medications with so few elderly patient subjects - and when you are speaking of escitalopram, the total was 69 patients - and universally state, "The number of elderly patients in these trials was insufficient to adequately assess for possible differential efficacy and safety measurements on the basis of age. Nevertheless, greater sensitivity to the effects of [the medication] cannot be ruled out." This, in my mind, does not promote confidence when prescribing. Likewise, as you well point out, the technical quality of this study speaks to the unreliable nature of 2nd & 3rd tier journals, and the constant "shopping" & media promotion of questionable studies. It is a constant, unending fight...
For initial approval it would not be ideal as there are way too many age related confounders that could impact safety and efficacy. With that said though - just like we do with children - there should be a post-marketing surveillance study looking at this age group specifically if these will be prescribed to them. I agree with much of your concerns on all fronts! And I would add it terrifies me to think that low dose antipsychotics and tricyclic antidepressants are overly prescribed for insomnia in this group and doctors always “forget” and may already have them on antidepressants and anti anxiety meds at the same time too. I have had to help with de-prescribing many times in this area and to chose better therapies, reduce drugs taken and minimize side effects for the elderly. This happens because different doctors are prescribing and the US still does not have a centralized way to track patients to prevent this kind of situation (and likely would impact opioid over prescription as well).
As I recall there is a blackbox warning regarding antipsychotics & dementia patients that were being prescribed for hallucinations and aggression, but likewise "forgotten" by prescribers, but nothing similar for SSRIs. Nonsensical. I supervize a handful of 1st year psychiatry residents who were unaware/"shady" of the Beers Criteria so I had a tech print it for them <sigh>. As I said, it's a constant...
I've been on Lexapro for several years now. I see no reason to think my mind is going to mush more quickly because of this. There's also the extreme way of looking at it like this. No SSRI at my current age could have led to self harm as bad as suicide. SSRI would at least help me live a life long enough to dementia, which would likely be decades. Based on that over-dramatic reasoning, I'll stick with the Lexapro.
I would love to see a similar detailed look at the evidence for dementia development in the setting of long-term benzodiazepine use. I might be wrong, but my feeling is also that it is not so straight forward, especially when you realise that dementia may affect sleep quality. So did the medicine cause the dementia, or did pre-clinical dementia lead to increased benzodiazepine use, say as a sleep aid?
Interesante investigación.
It is disconcerting to find that the FDA allows manufacturers to submit clinical trials data on SSRI/SNRI medications with so few elderly patient subjects - and when you are speaking of escitalopram, the total was 69 patients - and universally state, "The number of elderly patients in these trials was insufficient to adequately assess for possible differential efficacy and safety measurements on the basis of age. Nevertheless, greater sensitivity to the effects of [the medication] cannot be ruled out." This, in my mind, does not promote confidence when prescribing. Likewise, as you well point out, the technical quality of this study speaks to the unreliable nature of 2nd & 3rd tier journals, and the constant "shopping" & media promotion of questionable studies. It is a constant, unending fight...
For initial approval it would not be ideal as there are way too many age related confounders that could impact safety and efficacy. With that said though - just like we do with children - there should be a post-marketing surveillance study looking at this age group specifically if these will be prescribed to them. I agree with much of your concerns on all fronts! And I would add it terrifies me to think that low dose antipsychotics and tricyclic antidepressants are overly prescribed for insomnia in this group and doctors always “forget” and may already have them on antidepressants and anti anxiety meds at the same time too. I have had to help with de-prescribing many times in this area and to chose better therapies, reduce drugs taken and minimize side effects for the elderly. This happens because different doctors are prescribing and the US still does not have a centralized way to track patients to prevent this kind of situation (and likely would impact opioid over prescription as well).
As I recall there is a blackbox warning regarding antipsychotics & dementia patients that were being prescribed for hallucinations and aggression, but likewise "forgotten" by prescribers, but nothing similar for SSRIs. Nonsensical. I supervize a handful of 1st year psychiatry residents who were unaware/"shady" of the Beers Criteria so I had a tech print it for them <sigh>. As I said, it's a constant...
Oh lort! 🫣