The antidepressant drug citalopram (brand names Celexa or Cipramil) can significantly relieve agitation in patients with Alzheimer’s disease, according to the results of a clinical trial led by Johns Hopkins researchers. The drug may be a safer alternative to antipsychotic drugs which are currently used as first-line medicine to treat the condition.
For the study, published in the Journal of the American Medical Association, researchers recruited 186 patients with Alzheimer’s disease who exhibited a variety of symptoms including emotional distress, excessive movement, aggression, disruptive irritability, and disinhibition.
None of the participants had received adequate relief from alternative therapies, and some had experienced failed treatment with antipsychotic drugs. At the onset of the study, patients underwent tests to determine their agitation levels, memory and other cognitive skills, and their caregivers’ stress levels — a factor strongly linked to the well-being of patients.
For nine weeks, one patient group took increasing doses of citalopram up to 30 milligrams per day, and the other group took a placebo.
At the end of the study, the same tests were administered, along with electrocardiograms. “The patients who had taken citalopram had significant relief from their agitation symptoms,” said Constantine Lyketsos, M.D., M.H.S., director of the Johns Hopkins Memory and Alzheimer’s Treatment Center.
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. The caregivers of these patients also reported less stress.
However, patients on the drug were more likely to have slightly decreased cognitive function. “It was not huge, but measureable,” says Lyketsos, who is also director of the Department of Psychiatry at Johns Hopkins Bayview Medical Center. “That introduces a tradeoff.”
“Another drawback,” he said, i”s that participants taking citalopram had longer QTc intervals, an indicator of abnormal heart function that increases the risk of heart attacks. However,” Lyketsos said, “antipsychotic drugs increase heart attack risk as well, perhaps even more substantially.”
The researchers hope to test the effectiveness of a lower dose of citalopram which would have less risk for cognition and heart function. “In the meantime, he said, “the drug offers an alternative to antipsychotics.”
“If the agitation is not responding to non-medication treatments and your patient’s agitation isn’t improving, there are no great options,” Lyketsos said. “But here’s another medication choice that might be safer than other medications and seems to be just as effective.”
Source: Johns Hopkins