Medication for PTSD Could Increase the Risk of Dementia

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Dementia Risk is Heightened for PTSD Sufferers, Especially with Psychotropic Medication Treatments.

Post Traumatic Stress Disorder (PTSD) patients could be risking an increased likelihood of dementia if they take psychotropic medications. A recent study from the University of Iowa has found that there is a strong connection between psychotropic medication use and the onset of dementia. The researchers at the university have analyzed the data from more than 3 million US veterans to come to this conclusion.

How PTSD Happens

Post Traumatic Stress Disorder (PTSD) is triggered by experiencing a single traumatic event or a series of similarly related traumas. This is a type of anxiety resulting from the experience of an event causing extreme shock, fear, and/or feelings of helplessness. There is often a neurological component to PTSD as well that makes the treatment even more difficult to balance.

Many people experience a short period of time when it is difficult to adjust or cope after a traumatic event in their lives. Most people gradually improve over time with fewer neurological and psychological symptoms.  Exactly why is not known, but it has been estimated that up to 15% of all traumatic situations leave major lasting impressions on those who experience the events.

Sometimes the symptoms worsen and last for several months, years, or over the person’s lifetime. The Anxiety and Depression Associate of America list these PTSD symptoms as:

  • Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.
  • Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
  • Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.

The symptoms range from relatively minor to where they can be completely debilitating for the sufferer. Importantly, there is no common character trait (or flaw) that makes a person develop PTSD as a result of a trauma. Sometimes one person develops PTSD from what appear to be the same circumstances where another person escapes relatively unscathed.

PTSD in the Military vs The General Population

The United States Department of Veterans Affairs states that about 7 or 8 % of all Americans will experience PTSD and its symptoms for some period of time, at least once in their lives. In comparison, estimates are that about 9 to 9.5% of Americans have diabetes. PTSD is not uncommon.

PTSD is more common among people who are in the military, or who have careers where they have more frequent exposures to life threatening and otherwise traumatic experiences. The current statistics are that about 15 % of veterans who had served in Vietnam have been diagnosed with PTSD. About 12 % of veterans who served in the Gulf Wars are being treated for PTSD each year. Active military service appears to be about twice as likely to create a PTSD diagnosis as the rest of the American population.

Many previous studies have found that individuals suffering with PTSD are likely at greater risk for dementia and general cognitive decline. For this study, Dr. Abrams and his colleagues wanted to explore this connection further, while investigating how the medications that are used in the treatment of PTSD impact that dementia risk.

PTSD and Dementia

Dementia develops as a result of the death of brain cells. Symptoms include a decline in learning capacity, both short and long term memory skills, and other cognitive functions. Precisely what begins to trigger this process in some people and not in others has remained unclear.

The most common form of dementia is Alzheimer’s disease. It accounts for about 60 to 80 % of dementia cases.  About 5.5 million Americans have Alzheimer’s disease. About 5.3 million of them are over the age of 65.

Veterans with PTSD are at a significantly higher risk of developing dementia symptoms than those without PTSD. That risk varies based on which medications the veterans were using to control their PTSD symptoms.

The study findings were recently published in the Journal of the American Geriatrics Society. The study co-author is Dr. Thad Abrams who works out of the Department of Epidemiology at Iowa. The research team reviewed health data from the medical files of 3,139,780 American veterans. Their average age was 68 years. The final analysis included the medical files of 417,172 veterans.

In the beginning of the study in 2002-2003, 22,674 participants had been diagnosed with PTSD, but none of them had any signs of dementia or specific cognitive impairments.

The follow-up was over the course of 9 years. At the end of the study, 25,639 of the veterans had eventually received a dementia diagnosis.

The veterans who were not on any medications in the beginning of the study, if they had PTSD they were still significantly more likely to have dementia at follow-up 9 years later.

Using certain medications also influenced the dementia risk significantly.

SSRIs, Novel Antidepressants and Atypical Antipsychotics

The critical factor seemed to be the use of novel antidepressants, selective serotonin reuptake inhibitors, and atypical antipsychotics. Veterans taking these drugs were found to have the greatest risk of dementia, whether they had PTSD or not. The combination of both PTSD and the use of the medication caused the highest risks.

The researchers commented, “PTSD diagnosis is associated with an increased risk for dementia diagnosis that varied with receipt of psychotropic medications.”

The researchers say based on these findings that psychoactive medications might be influencing how PTSD changes the risk of developing dementia, but they cautiously note that further studies will be needed to know for certain.

“Although our results showed significant independent and effect modifying impacts, the association between psychotropic medication use and the risk of dementia remains an area for further inquiry,” say the research team members.

They have specifically recommended further research to account for the dosage, usage duration, and diagnostic indications for the initial use. This would determine if the modifying impact of the medication use on the dementia risk is due to the differences in the severity of the PTSD symptomatology, other psychiatric comorbidities, or if they are representative of independent, direct effects on the dementia neuropathogenesis.”

What does seem clear though is that although there may be some short term benefit to using these medications for patients with (or without) PTSD, the long term risk of dementia needs to be weighed by both physician and patient.

References:
Journal of the American Geriatrics Soicety
U.S. Department of Veterans Affairs
Alzheimer’s Association
Anxiety and Depression Society of America

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Pharmaceutical analyst who loves blogging about health and medical issues. Has written more than 150 articles and a book on attention deficit disorder. Correctly predicted delayed approval of Bydureon, approval of Provenge by FDA, and the non-approval of Acthar on June 11.

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