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Randomized Controlled Trial
. 2025 Jun 3;26(1):190.
doi: 10.1186/s12875-025-02894-y.

Effects of deprescribing antidepressants in nursing home residents with dementia-a cluster randomized controlled trial

Pernille Hølmkjær  1 , Maarten Pieter Rozing  2 , Gritt Overbeck  2 , Volkert Siersma  2 , Anne Holm  2
Affiliations
Randomized Controlled Trial

Effects of deprescribing antidepressants in nursing home residents with dementia-a cluster randomized controlled trial

Pernille Hølmkjær et al. BMC Prim Care. .

Abstract

Background: Older nursing home residents with dementia are commonly prescribed antidepressants despite limited evidence of clinical effect and a high risk of side effects. Deprescribing can be challenging and is often not attempted. The aim of the study is to investigate the effect of a multifaceted intervention targeting nursing home general practitioners and their collaboration with the nursing home staff on the reduction of antidepressant medication in older nursing home residents with dementia.

Method: The study is a cluster-randomized, non-blinded, controlled trial. General practitioners working as nursing home physicians in the Capital Region of Denmark were recruited between June 1 and October 1, 2021. Eligible participants were individuals with dementia (diagnosed or suspected), ≥ 72 years old, receiving one or more antidepressants, and living in a nursing home with the associated nursing home physician. The complex intervention consisted of three main parts: 1) a training session occurring in the nursing home, 2) a pre-visit reflection tool, and 3) a dialog tool used during a structured home visit at the nursing home. The control group received enhanced care as usual. Primary outcome was the reduction of the total defined daily dose of antidepressants from pre- to post-intervention in the intervention group, compared to the control group. Secondary outcomes included mortality, changes in other psychotropic medication, hospitalization, and symptoms changes.

Results: We recruited 21 clusters with 128 eligible participants (62/66 in intervention and control). Four clusters withdrew. Most participants were women, and the median age was 85. They received an average of nine different drugs, and the most commonly prescribed antidepressants were sertraline and mirtazapine. The OR for the reduction of antidepressants in the intervention group versus control was 2.3 (95% CI = 0.84-6.2). Mortality rates were similar between groups.

Conclusions: The intervention did not significantly reduce antidepressant use among older nursing home residents with dementia. Further optimization and testing in a larger study are needed.

Trial registration: ClinicalTrials.gov ID NCT04985305, registration date: 2021-08-02.

Keywords: Antidepressants; Dementia; Deprescribing; General practice; Nursing home.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in compliance with the Helsinki Declaration in its latest form, good clinical practice guidelines, and followed the rules for informed consent. The Regional Ethical Committee was informed about the trial and waivered ethical approval according to Danish legislation (Journal no: H-20084023). The University of Copenhagen approved study procedures and informed consent was obtained verbally and recorded from all participants according to Danish legislation concerning non-intervention trials. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
step-wise description on how the three parts of the intervention was used. The three parts of the intervention presented as the three steps were performed. GP = general practitioner
Fig. 2
Fig. 2
Consolidated Standards of Reporting Trials (CONSORT) Diagram of Participants in the Study. Participant flow and numbers included in primary outcome analysis; CONSORT 2010 flow diagram. CONSORT: Consolidated Standards of Reporting Standards; N = all participants, n: sample, GP = general practitioner
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References

    1. Lundby C, Jensen J, Larsen SP, Hoffmann H, Pottegård A, Reilev M. Use of medication among nursing home residents: a Danish drug utilisation study. Age Ageing. 2020;49(5):814–20. 10.1093/ageing/afaa029. - PubMed
    1. Sundhedsdatastyrelsen. eSundhed: Antipsykotika [antipsychotics]. 2022. https://www.esundhed.dk/Emner/Laegemidler/Antipsykotika. Accessed December 12. 2023.
    1. Kessing LV, Harhoff M, Andersen PK. Treatment with antidepressants in patients with dementia–a nationwide register-based study. Int Psychogeriatr. 2007;19(5):902–13. 10.1017/s1041610206004376. - PubMed
    1. Farina N, Morrell L, Banerjee S. What is the therapeutic value of antidepressants in dementia? A narrative review. Int J Geriatr Psychiatry. 2017;32(1):32–49. 10.1002/gps.4566. - PubMed
    1. Coupland CA, Dhiman P, Barton G, Morriss R, Arthur A, Sach T et al. A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. Health Technol Assess. 2011;15(28):1–202, iii-iv. 10.3310/hta15280. - PubMed

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