Which antidepressant should be avoided in a patient with mild cognitive impairment and depression to reduce the risk of worsening cognition?

Paroxetine is known to have anticholinergic properties, which can lead to cognitive decline, especially in elderly patients or those with pre-existing cognitive impairment. Anticholinergic effects may exacerbate symptoms of cognitive dysfunction, making it crucial to avoid paroxetine in individuals with mild cognitive impairment. This aligns with clinical recommendations to utilize antidepressants that have a more favorable cognitive profile for such patients.

In contrast, other options like bupropion, mirtazapine, and venlafaxine tend to have lesser anticholinergic effects and are often considered safer choices for patients with cognitive issues. For instance, bupropion is a norepinephrine-dopamine reuptake inhibitor that does not exhibit significant anticholinergic activity. Mirtazapine, while it can cause sedation, does not have strong anticholinergic effects either. Venlafaxine is primarily a serotonin-norepinephrine reuptake inhibitor, which also tends not to adversely impact cognition. Therefore, the recommendation to avoid paroxetine in patients with cognitive impairment is based on its potential to worsen cognitive function.