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Citalopram Reduces Agitation in Some Patients with Alzheimer Disease

Summary and Comment |
February 24, 2014

Citalopram Reduces Agitation in Some Patients with Alzheimer Disease

  1. Thomas L. Schwenk, MD

But adverse effects are worrisome.

  1. Thomas L. Schwenk, MD

Agitation in patients with Alzheimer disease (AD) causes substantial patient and caregiver distress, but no drugs have been FDA approved for managing this condition. In this multicenter North American study, researchers randomized 186 older adults (mean age, 78) with probable Alzheimer disease and clinical agitation to citalopram (titrated to a target dose of 30 mg daily) or placebo. Participants lived at home and received several hours of caregiver support weekly; they received a standard set of educational, crisis management, and counseling services. Baseline depression, psychosis, or prolonged QTc interval were exclusion criteria.

At 9 weeks, citalopram patients had significantly lower scores on standardized measures of agitation than did controls; caregivers in the citalopram group reported lower stress levels. About 40% of citalopram patients had moderate or better improvement in agitation versus 26% of controls (number needed to treat, 7). However, citalopram patients experienced more frequent and more substantial adverse events, including worsening of cognitive function and anorexia, diarrhea, and falls. Participants who received citalopram were more likely to exhibit increases of ≥30 milliseconds in QTc interval (7 intervention patients vs. 1 control patient).

Comment — GENERAL MEDICINE

  1. Thomas L. Schwenk, MD

These results are both encouraging and worrisome. Citalopram appears to reduce agitation, at least in some patients, with concomitant benefits to caregivers; however, its side effects could detract substantially from overall quality of life and could cause cardiac complications or death. An editorialist believes that cautious use in selected patients might be warranted.

Comment — PSYCHIATRY

  1. Jonathan Silver, MD

Alternatives to citalopram in treating agitated patients with AD include atypical antipsychotics, but this approach has several concerning adverse effects, from metabolic problems to increased risk for death (NEJM JW Psychiatry Feb 6 2012). Although citalopram itself is associated with prolonged QT intervals, this can be monitored by electrocardiograms obtained pretreatment and after initiation. Agitation is a frequent problem in elderly people with dementia, and clinicians are in need of more definitive guidance, as noted in another recent study (NEJM JW Psychiatry Aug 9 2013).

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

  • Disclosures for Jonathan Silver, MD at time of publication Editorial boards Journal of Neurology, Neurosurgery and Psychiatry; Journal of Neuropsychiatry and Clinical Neuroscience; UpToDate Leadership positions in professional societies North American Brain Injury Association (Board Member) Editorial Boards Journal of Neurology, Neurosurgery & Psychiatry; Journal of Neuropsychiatry and Clinical Neurosciences

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Reader Comments (1)

HUY HOANG Physician, Internal Medicine, 10530 Bolsa Ave #C Westminster CA 92683

Very good article

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