Common antidepressant eases Alzheimer’s agitation

Agitation can be one of the most heartbreaking symptoms of Alzheimer's. Caregivers watch as their loved ones become increasingly short-tempered, physically restless, resistant to help, or even verbally and physically abusive. (Credit: A S/Flickr)

High doses of a common antidepressant drug significantly reduce agitation in people with Alzheimer’s.

Agitation is one of the most common reasons patients are moved out of their homes and treatment options are limited. Antipsychotics are often prescribed, but these significantly increase a patient’s risk of a stroke, heart attack, or death.

For a new study, published in the Journal of the American Medical Association, 30 milligrams of the drug citalopram were given to 94 patients with agitation. Another group of 92 patients with these symptoms took a placebo. At the end of the study, 40 percent of patients who took citalopram had “considerable relief” from their agitation symptoms, compared to 26 percent in the placebo group.

Researchers obtained these result by comparing the results of two common rating scales administered by clinicians at the beginning and the end of the study.

In addition, caregivers of patients taking citalopram experienced reduced caregiver distress, further illustrating the clinical relevance of the treatment and its impact.

“It has been a long time since we’ve had such positive results in a field that has seen a sea of negative study results,” says Anton P. Porsteinsson, a professor at the University of Rochester and lead author of the study.

Limited options

Citalopram, sold under the brand names Celexa and Cipramil, is one of the most common antidepressants taken by older adults in America. However, the FDA recommends a maximum dose of 20 milligrams of citalopram for older adults to avoid risk of QT interval prolongation, a heart rhythm disorder that could eventually lead to death if not successfully treated. 

Patients in this study were monitored, and researchers confirmed a greater increase in QT interval occurred in the group of patients taking citalopram.

“There are very limited options for the treatment of this tremendously distressing and difficult to treat behavioral disruption,” says Porsteinsson.  “If non-pharmacological intervention is not beneficial, judicious use of citalopram appears to have a role in managing agitation in patients with Alzheimer’s disease but generally the dose should not surpass 20 mg daily.”

Researchers from Johns Hopkins University, Columbia University, Stanford University, the University of Pennsylvania, the University of Toronto, the University of Southern California, and the Medical University of South Carolina contributed to the study.

Source: University of Rochester