Tuesday, January 19, 2016

Effectiveness of Citalopram for Agitation in Alzheimer’s May Be Limited to Subset of Patients

Citalopram may be of limited use for the treatment of agitation in patients with Alzheimer’s disease, according to a report online in AJP in Advance.

Researchers from the Citalopram for Agitation in Alzheimer Disease (CitAD) trial found that while patients with mild cognitive impairment and moderate agitation showed some improvements when taking citalopram, placebo proved more effective than citalopram for patients experiencing severe cognitive impairment and agitation.

As was described in a 2014 report on the CitAD trial, 186 patients with Alzheimer’s disease and clinically significant agitation were randomly assigned to receive citalopram or placebo for 9 weeks, with the dosage titrated to 30 mg/day over the first 3 weeks. Although citalopram at 30 mg/day was associated with a reduction in agitation in patients with Alzheimer’s disease comparable with placebo, the trial also revealed that some patients taking citalopram experienced a worsening of cognition and adverse cardiac effects.

For the current report, researchers analyzed subgroups of the CitAD participants to see if they could determine variables associated with response or lack of response between citalopram and placebo treatments. The researchers found that patients who responded better to citalopram were more likely to be living outside long-term care facilities, have the least cognitive impairment, and have moderate agitation, among other factors. In contrast, patients who responded more favorably to placebo were more likely to be living in long-term care, have moderate to severe cognitive impairment, and have more severe baseline agitation, among others variables.

“The finding that patients with more severe agitation or aggression responded better with placebo or poorly with citalopram raises further caution,” the study authors wrote. “Given these results, along with the established associations of citalopram with delayed cardiac repolarization and with cognitive impairment, and given safety concerns of antidepressants for depressed elderly patients and the FDA’s recommendation to avoid citalopram dosages over 20 mg/day in patients over age 60, citalopram may have limited use for treating agitation in Alzheimer’s disease.”

For related information, see the Psychiatric News article “Combination of Dextromethorphan, Quinidine Reduces Agitation in Alzheimer's Patients.”

(Image: Richard Lyons/Shutterstock)


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