New research suggests that an antidepressant (citalopram) may perform as well as a commonly-prescribed antipsychotic (risperidone) in the alleviation of severe agitation and psychotic symptoms of dementia.
Moreover, the antidepressant was associated with “significantly lower” adverse side effects.
The finding surprised researchers and may represent a new direction in drug treatment for psychotic disorders related to dementia in the elderly.
However, additional studies are needed to replicate the findings. In the meantime, second generation antipsychotics continue to be a first-line pharmacological treatment, despite growing scientific evidence that they can be associated with serious side effects, including death.
The study, published in the online American Journal of Geriatric Psychiatry (in advance of the November 2007 issue), is believed to be the first head-to-head comparison of an SSRI (selective serotonin reuptake inhibitor) with one of the more commonly prescribed second generation antipsychotics in older, non-depressed patients.
“We are encouraged by this early data, but we need to learn more in further trials that include a placebo group before we can say with confidence that antidepressants are an effective and safe treatment for agitation and psychosis in patients suffering from dementia,” says lead investigator Dr. Bruce Pollock, who teamed up with colleague Dr. Benoit Mulsant to conduct the study.
Drs. Pollock and Mulsant conducted a double-blind randomized control trial of citalopram (antidepressant) and risperidone (antipsychotic) to compare the efficacy and safety of the two drugs in 103 patients who were hospitalized with psychiatric disturbances related to dementia at the University of Pittsburgh Medical Center.
The researchers were surprised to find that citalopram and risperidone had similar efficacy in reducing psychosis (hallucinations, delusions, suspicious thoughts) and agitation.
Overall, there was a 32 percent reduction of symptoms with citalopram and a 35 percent reduction with risperidone. Citalopram was associated with a significantly lower burden of adverse side effects, such as sedation, tension and apathy. Total side effect burden scores increased 19 percent for risperidone and decreased by 4 percent with citalopram.
“We didn’t expect that an antidepressant would have so-called antipsychotic properties,” adds Dr. Mulsant.
“It reinforces our belief that psychosis and agitation have a different neurochemistry in older patients with dementia and in younger patients with schizophrenia, even though both groups of patients are currently treated with the same medications (antipsychotics).”