{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:53:02Z","timestamp":1791262382214,"version":"4.1.0"},"reference-count":69,"publisher":"National Institute for Health and Care Research","issue":"7","license":[{"start":{"date-parts":[[2013,2,1]],"date-time":"2013-02-01T00:00:00Z","timestamp":1359676800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Objective<\/jats:title><jats:p>Depression is common in dementia, causing considerable distress and other negative impacts. Treating it is a clinical priority, but the evidence base is sparse and equivocal. This trial aimed to determine clinical effectiveness of sertraline and mirtazapine in reducing depression 13 weeks post randomisation compared with placebo.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-2\"><jats:title>Design<\/jats:title><jats:p>Multicentre, parallel-group, double-blind placebo-controlled randomised controlled trial of the clinical effectiveness of sertraline and mirtazapine with 13- and 39-week follow-up.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-3\"><jats:title>Setting<\/jats:title><jats:p>Nine English old-age psychiatry services.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-4\"><jats:title>Participants<\/jats:title><jats:p>A pragmatic trial.<jats:italic>Eligibility<\/jats:italic>: probable or possible Alzheimer's disease (AD), depression (4+ weeks) and Cornell Scale for Depression in Dementia (CSDD) score of 8+.<jats:italic>Exclusions<\/jats:italic>: clinically too critical (e.g. suicide risk); contraindication to medication; taking antidepressants; in another trial; and having no carer.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-5\"><jats:title>Interventions<\/jats:title><jats:p>(1) Sertraline; (2) mirtazapine; and (3) placebo, all with normal care. Target doses: 150 mg of sertraline or 45 mg of mirtazapine daily.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-6\"><jats:title>Main outcome measures<\/jats:title><jats:p><jats:italic>Outcome<\/jats:italic>: CSDD score.<jats:italic>Randomisation<\/jats:italic>: Allocated 1 : 1 : 1 through Trials Unit, independently of trial team. Stratified block randomisation by centre, with randomly varying block sizes; computer-generated randomisation.<jats:italic>Blinding<\/jats:italic>: Double blind: medication and placebo identical for each antidepressant. Referring clinicians, research workers, participants and pharmacies were blind. Statisticians blind until analyses completed.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-7\"><jats:title>Results<\/jats:title><jats:p><jats:italic>Numbers randomised<\/jats:italic>: 326 participants randomised (111 placebo, 107 sertraline and 108 mirtazapine).<jats:italic>Outcome<\/jats:italic>: Differences in CSDD at 13 weeks from an adjusted linear-mixed model: mean difference (95% CI) placebo\u2013sertraline 1.17 (\u22120.23 to 2.78;<jats:italic>p<\/jats:italic>\u2009=\u20090.102); placebo\u2013mirtazapine 0.01 (\u22121.37 to 1.38;<jats:italic>p<\/jats:italic>\u2009=\u20090.991); and mirtazapine\u2013sertraline 1.16 (\u22120.27 to 2.60;<jats:italic>p<\/jats:italic>\u2009=\u20090.112).<jats:italic>Harms<\/jats:italic>: Placebo group had fewer adverse reactions (29\/111, 26%) than sertraline (46\/107, 43%) or mirtazapine (44\/108, 41%;<jats:italic>p<\/jats:italic>\u2009=\u20090.017); 39-week mortality equal, five deaths in each group.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-8\"><jats:title>Conclusions<\/jats:title><jats:p>This is a trial with negative findings but important clinical implications. The data suggest that the antidepressants tested, given with normal care, are not clinically effective (compared with placebo) for clinically significant depression in AD. This implies a need to change current practice of antidepressants being the first-line treatment of depression in AD. From the data generated we formulated the following recommendations for future work. (1) The secondary analyses presented here suggest that there would be value in carrying out a placebo-controlled trial of the clinical effectiveness and cost-effectiveness of mirtazapine in the management of Behavioural and Psychological Symptoms of Dementia. (2) A conclusion from this study is that it remains both ethical and essential for trials of new medication for depression in dementia to have a placebo arm. (3) Further research is required to evaluate the impact that treatments for depression in people with dementia can have on their carers not only in terms of any impacts on their quality of life, but also the time they spend care-giving. (4) There is a need for research into alternative biological and psychological therapies for depression in dementia. These could include evaluations of new classes of antidepressants (such as venlafaxine) or antidementia medication (e.g. cholinesterase inhibitors). (5) Research is needed to investigate the natural history of depression in dementia in the community when patients are not referred to secondary care services. (6) Further work is needed to investigate the cost modelling results in this rich data set, investigating carer burden and possible moderators to the treatment effects. (7) There is scope for reanalysis of the primary outcome in terms of carer and participant CSDD results.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-9\"><jats:title>Trial registration<\/jats:title><jats:p>EudraCT Number \u2013 2006\u2013000105\u201338.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-10\"><jats:title>Funding<\/jats:title><jats:p>This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 7. See the HTA programme website for further project information.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta17070","type":"journal-article","created":{"date-parts":[[2014,10,13]],"date-time":"2014-10-13T11:53:29Z","timestamp":1413201209000},"page":"1-166","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":112,"title":["Study of the use of antidepressants for depression in dementia: the HTA-SADD trial \u2013 a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine"],"prefix":"10.3310","volume":"17","author":[{"given":"S","family":"Banerjee","sequence":"first","affiliation":[{"name":"Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Hellier","sequence":"additional","affiliation":[{"name":"King's College London, Mental Health 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