The findings, which are based on a secondary analysis of the Citalopram for Agitation in Alzheimer’s Disease (CitAD) study, suggest citalopram may offer a therapeutic alternative to antipsychotics, which are commonly prescribed to treat agitation and irritability in Alzheimer’s patients. However, the authors cautioned that dosage constraints must be considered because of citalopram’s adverse-effect profile in this population.
For the CitAD study, 186 individuals who were diagnosed with probable Alzheimer’s disease and “clinically significant agitation” were randomly assigned to receive citalopram (30 mg/day) or placebo daily for nine weeks. Participants in the citalopram group showed a significant reduction in agitation compared with those in the placebo group, according to the Neurobehavioral Rating Scale agitation subscale and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change.
In the current analysis, the authors examined the effects of citalopram treatment on neuropsychiatric symptoms in addition to agitation, as rated on the Neuropsychiatric Inventory (NPI). (In the primary analysis of CitAD, the researchers saw that citalopram reduced overall NPI scores, but not the agitation subdomain, suggesting improvements in other symptoms might be driving patient improvement.)
After nine weeks, participants in the citalopram group were significantly less likely to have reports of delusions (odds ratio=0.40), anxiety (odds ratio=0.43), and irritability (odds ratio=0.38) compared with the placebo group. Median domain scores among the patients with reports of a symptom at week 9 were lower in the citalopram group compared with the placebo group for hallucinations, but higher for sleep/nighttime behavior disorders.
“Citalopram at a dosage of 30 mg/day shows efficacy for the treatment of agitation and appears to be similarly effective for a broad range of concomitant neuropsychiatric symptoms, particularly delusions, anxiety, and irritability/lability,” the authors wrote. “While citalopram is a therapeutic option for the treatment of agitation in Alzheimer’s disease even when psychotic symptoms are present, the concerning side effects of cognitive worsening and delayed cardiac repolarization seen in this study as well as safety concerns with depressed elderly patients urge dosage constraints and caution.”
To read about more findings arising from the CitAD study, see the American Journal of Psychiatry article “Heterogeneity of Treatment Response to Citalopram for Patients With Alzheimer’s Disease With Aggression or Agitation: The CitAD Randomized Clinical Trial.”