“Up to 90 percent of people with dementia experience symptoms of agitation such as emotional distress, restlessness, aggression, or irritability, which is upsetting for patients and places a huge burden on their caregivers,” said psychiatrist and researcher Dr. Bruce G. Pollock.
“These symptoms are a major reason why people go into long-term care prematurely.”
In a study found in the Journal of the American Medical Association, the antidepressant significantly relieved agitation in a group of Alzheimer’s disease patients.
“When agitation occurs, it’s paramount to try non-medication approaches first, such as looking for underlying physical discomfort in a patient, reducing external triggers such as noise or overstimulation, and encouraging light exercise,” said Pollock, director of the Centre for Addiction and Mental Health Research (CAMH) Institute in Toronto.
When these approaches don’t work, antipsychotic medications are commonly used to treat agitation.
“Antipsychotics are not an ideal therapy and significantly increase the risk of strokes, heart attacks, and sudden death,” he said.
Based on promising early findings from Europe, Pollock began conducting studies on citalopram, which suggested it might be a viable treatment alternative to antipsychotics.
To provide stronger evidence, the Citalopram for Agitation in Alzheimer’s Disease Study (CitAD) was initiated with eight leading Alzheimer’s research centers across the United States and Canada, including the Geriatric Program at CAMH.
The study included 186 patients with Alzheimer’s disease who showed symptoms of agitation. Their average age was in the late 70s. None had experienced symptom relief with non-medication therapies, and some had failed treatment with antipsychotic drugs.
The study measured both patients’ agitation levels as well as their caregivers’ stress levels, a factor strongly linked to Alzheimer’s patients’ well-being.
Patients were then randomly assigned to receive either citalopram for nine weeks, up to a dose of 30 milligrams per day, or an identical-looking placebo. At the end of the study period, the tests were repeated.
Patients on the drug had significant relief from their agitation symptoms. In one measure of agitation, about 40 percent of patients who took citalopram had “considerable relief” compared to 26 percent of patients who took the placebo.
In addition, caregivers for these patients had significantly lower levels of stress.