International Psychogeriatrics

Research Article

Antidepressant use in Alzheimer's disease patients: results of the REAL.FR cohort

Christophe Arbusa1 c1, Virginie Gardettea2, Eric Buia1, Christelle Canteta2, Sandrine Andrieua2, Fati Nourhashémia2a3, Laurent Schmitta1, Bruno Vellasa2a3 and the REAL.FR Group

a1 Traumatic Stress Laboratory, Paul Sabatier University, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, Toulouse, France

a2 INSERM U558, Department of Epidemiology and Public Health, Faculty of Medicine, Toulouse, France

a3 Gerontopole, Department of Internal Medicine and Clinical Gerontology, Alzheimer Centre, Toulouse, France


Background: Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription.

Methods: REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI).

Results: A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI ≥ 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression.

Conclusions: The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.

(Received March 11 2009)

(Revised March 25 2009)

(Revised June 29 2009)

(Accepted July 01 2009)

(Online publication September 07 2009)


c1 Correspondence should be addressed to: Christophe Arbus, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, 31059 Toulouse, France. Phone: +33 561772351; Fax: +33 561777646. Email: