Citalopram May Alleviate Alzheimer’s Symptoms
Abstract
After nine weeks, patients taking 30 mg of citalopram daily were significantly less likely to have reports of delusions, anxiety, and irritability/lability compared with those in the placebo group.
Patients with Alzheimer’s disease (AD) who take citalopram may be less likely to experience delusions, anxiety, and irritability compared with those not taking the medication, according to a study published last month in AJP in Advance.
The findings stem from a secondary analysis of the Citalopram for Agitation in Alzheimer’s Disease (CitAD) study, which found that patients who took 30 mg of citalopram daily for three weeks experienced reduced agitation compared with those who took placebo.
“Delusions, anxiety, and irritability in persons with Alzheimer’s disease are a major source of distress for both patients and caregivers, and there are no FDA-approved treatments for these indications,” said former APA President Dilip Jeste, M.D., a professor of psychiatry and neuroscience and director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego.
Antipsychotic medications are commonly used to treat these symptoms, but they can have serious adverse effects in older patients, said Jeste, who was not involved with this trial. The demonstration of the usefulness of citalopram is notable “as it adds another option to the possible treatment armamentarium,” he told Psychiatric News.
As described in AJP in Advance, Anton Porsteinsson, M.D., director of the University of Rochester Alzheimer’s Disease Care Research and Education Program, and colleagues analyzed findings from a subsample of 186 people with probable AD and “clinically significant agitation” who were randomly assigned to take citalopram (30 mg/day) or placebo for nine weeks.
In addition to pharmacotherapy, participants and caregivers received a standardized practical psychosocial intervention that consisted of three components: provision of educational materials, 24-hour availability of crisis management services, and a 20- to 30-minute counseling session at each scheduled study visit. Patients and caregivers completed in-person visits at the start of the trial and again three, six, and nine weeks later.
The researchers used the Neurobehavioral Rating Scale agitation subscale and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change to assess changes in participant agitation over the course of the trial. Caregivers completed the Neuropsychiatric Inventory (NPI) at baseline and at three, six, and nine weeks, which assessed agitation and other neuropsychiatric symptoms of the study participants.
The most common psychiatric symptoms reported by patients at baseline included irritability/lability (84 percent), anxiety (65 percent), apathy/indifference (61 percent), aberrant motor behavior (52 percent), disinhibition (51 percent), and depression/dysphoria (51 percent).
After nine weeks, participants in the citalopram group were significantly less likely to have reports of delusions (odd ratio [OR]=0.40), anxiety (OR=0.43), and irritability/lability (OR=0.38) compared with those in the placebo group.
While it is clear from the findings that 30 mg of citalopram daily may help to reduce some psychiatric symptoms in patients with AD, Porsteinsson noted that more research into the safety of citalopram at this dose in older adults is needed.
“The FDA has issued guidelines that people over the age of 60 should take no more than 20 milligrams of citalopram due to issues with cognitive worsening and delayed cardiac repolarization,” he told Psychiatric News.
Although the findings suggest “that the 30-milligram dose is fairly well tolerated,” the FDA recommendations coupled with the “unclear cognitive worsening of unknown clinical significance” and delayed cardiac repolarization associated with this dose means that “we cannot recommend a broad use of 30 milligrams of citalopram per day,” Porsteinsson said.
He added that his group is planning to investigate whether 20 mg of citalopram can produce the same effects as those seen in the CitAD study.
Jeste noted that because citalopram is not yet approved by the FDA for adults over the age of 60 with AD and agitation and it has “several clinically important limitations, optimism about these encouraging findings should be coupled with due caution.”
This work was supported by grants from the National Institute on Aging, the National Institute of Mental Health, and the National Institutes of Health. ■
