Antidepressant: Citalopram in treating Alzheimer's agitation

The antidepressant drug Citalopram ( Celexa, Cipramil, Seropram ), significantly relieved agitation in a group of patients with Alzheimer's disease.
In lower doses than those tested, the drug might be safer than antipsychotic drugs currently used to treat the condition.

For the study, reported in the Journal of the American Medical Association ( JAMA ), researchers recruited 186 patients with Alzheimer's who showed a collection of symptoms including emotional distress, excessive movement, aggression, disruptive irritability and disinhibition.
None experienced adequate symptom relief with non-medical therapies, and some experienced failed treatment with antipsychotic drugs.
Though antipsychotics are often used as first-line medications for Alzheimer's-related agitation, they significantly increase the risk of strokes, myocardial infarction and death.

At the start of the study, patients also underwent tests to define the extent of their agitation, memory and other cognitive skills, and their caregivers' stress levels, a factor strongly linked to the well-being of those with Alzheimer's. The patients were then separated into two groups. For the next nine weeks, about half took increasing doses of Citalopram that peaked at 30 milligrams per day, and the rest took an identical-looking placebo.

At the end of the study period, the same set of tests was given, along with electrocardiograms. The study drug is linked to adverse effects on heart function, including irregular heartbeat, a harbinger of a heart attack.

Results showed that patients on the drug had significant relief from their agitation symptoms. In one measure of agitation, about 40% of patients who took Citalopram had considerable relief, compared to 26% of patients who took the placebo.
The caregivers for these patients reported less stress.

However, patients on the drug were also more likely to have slightly decreased cognitive function.

More concerning is that patients on Citalopram had longer QTc intervals, a measure of abnormal heart function that increases the risk of myocardial infarctions.
However, antipsychotic medications also used to treat agitation increase myocardial infarction risk as well, perhaps even more substantially. ( Xagena )

Source: Johns Hopkins Medicine, 2014


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