ArticleJournal of general internal medicine2026
Comparative Effectiveness of Antidepressants and Second-Generation Antipsychotics for Agitation Among Nursing Home Residents with Dementia.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundAgitation affects up to 80% of individuals with dementia and is particularly common among nursing home residents. Second-generation antipsychotics (SGAs) are frequently used to manage agitation but are associated with serious safety risks. Selective serotonin reuptake inhibitors (SSRIs) have been proposed as safer alternatives, though real-world comparative evidence is limited.
objectiveTo compare the real-world effectiveness of SSRIs versus SGAs for agitation among nursing home residents with dementia.
designNational active comparator new user cohort study.
participantsLong-stay US nursing home residents aged ≥ 65 years with dementia and agitation who newly initiated an SSRI or SGA from 2011 to 2018, based on Medicare claims and the Minimum Data Sets 3.0. MAIN MEASURES: Outcomes included change in Agitated and Reactive Behavior Scale score (continuous; range 0-12, higher = worse) and achieving minimal clinically important improvement (binary; ≥ 1-point decline) from baseline to 60-120 days. Weighted linear models incorporating overlap propensity score and inverse probability of censoring weights within generalized estimating equation models estimated adjusted treatment effects in intention-to-treat and as-treated analyses. KEY
resultsAmong 19,508 SSRI and 21,541 SGA new users, baseline characteristics were well balanced after weighting. In as-treated analyses, SSRI new users experienced greater mean reductions in Agitated and Reactive Behavior Scale score (difference: - 0.14 [95% CI, - 0.19 to - 0.09]) and a higher probability of achieving minimal improvement (difference: 3.6% [95% CI, 2.7 to 4.6]) compared with SGA new users. These differences were most pronounced among residents with mild-to-moderate agitation and mild-to-moderate cognitive impairment.
conclusionInitiation of SSRIs was associated with modest improvements in agitation compared with SGAs among US nursing home residents with dementia. These findings support SSRIs as potential pharmacologic alternatives to antipsychotics and provide real-world evidence relevant to dementia care, particularly given FDA black box warnings for antipsychotics.
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