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Citalopram Associated with Reduced Agitation in Alzheimer's, But at What Cost? — Physician’s First Watch

Medical News |
February 19, 2014

Citalopram Associated with Reduced Agitation in Alzheimer's, But at What Cost?

By Kelly Young

The selective serotonin reuptake inhibitor citalopram is associated with reduced agitation in people with Alzheimer disease — but with significant side effects — according to a JAMA study.

Nearly 200 patients with probable Alzheimer's and significant agitation were randomized to receive either daily citalopram (target dose: 30 mg) or placebo. Both groups also received a psychosocial intervention.

At 9 weeks, patients in the citalopram group showed improvements in agitation scores, as well as a reduction in caregiver distress, relative to the placebo group. However, the citalopram group had greater cognitive decline and a greater increase in the QT interval.

Given these side effects, the authors say citalopram "cannot be generally recommended as an alternative treatment option at that dose." Thomas Schwenk, a family medicine physician with NEJM Journal Watch, calls the results both "encouraging and worrisome," noting that "the side effects could detract significantly from overall quality of life, and possibly cause cardiac complications or death."

Reader Comments (7)

ALI MADI Physician, Pulmonary Medicine, Tripoli-libya

The number of patients included in this is not big enough to be significant .most drugs known to reduce agitation they have cognitive function impairment as a side effect..

EHSAN AZIMI Physician, Geriatrics

Most important finding is improvement in both groups with psychosocial interventions, reminding us that not all problems need a pill.

Unfortunately, limited time and resources limit ability to properly use these nonpharmacologic treatments in real life. A simple intervention may be to refer to Alzheimer's Association for psychosocial interventions (if you have good chapter in your area).

Claire Gervais, MD Physician, Family Medicine/General Practice, UW Madison

My 87 yr old mother with advanced Alzheimer's and chronic anxiety and depression in on citalopram at a lower dose and it works well for her agitation. We are leaving things be given her age and stage.

Kelly Other Healthcare Professional, Psychiatry

I used celexa (now lexapro) for years instead of benzos or antipsychotics very successfully for agitation especially in early stages where the person is fearful with low frustration tolerance. What is the lesser of the 2 evils???
I question the cognitive decline research.

Barbara Solomon-Speregen MS Other

Given that AD is fatal, isn't amelioration of the patient's mental health worth this risk?

David Weber, MD Physician

Thanks for the comment. Sometimes, I feel like the little boy in the story about the emperor's new clothes.

N BROUGH

I totally agree with the above comment about AD prognosis. I'd rather see improved agitation (thus easing the discomfort to the patient as well as improving caregiver stress) than increasing the length of life. Aside from the religious folks, anyone who cares for an AD patient knows the reality and advisability of improving agitation, manageability, and a timely death.

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