A drug intended to
treat depression has been found to reduce agitation in people with Alzheimer's
disease. The drug, citalopram (Celexa), appears to be a safer alternative to
the traditional antipsychotic medicines used for agitation. Doctors typically prescribe
antipsychotics after nondrug treatments, such as behavioral therapy, fail to
calm patients.
In a randomized
clinical trial reported in JAMA (volume 311, p. 683), Johns Hopkins scientists
studied 186 people, average ages 78-79, with Alzheimer's who had symptoms of
agitation such as emotional distress, irritability, aggressive behavior, verbal
or physical outbursts and restlessness.
They gave about half
the patients citalopram with gradually increasing doses up to 30 mg. The
remaining patients received a placebo. Participants in both groups, and their
caregivers, received counseling as well. After nine weeks, 40 percent of the
patients in the citalopram group showed marked improvement in agitation
symptoms, compared with 26 percent in the placebo group. Caregivers of patients
who received citalopram also reported less stress.
The risks - Citalopram,
however, does have some risks; the FDA advises people over 60 to avoid doses
above 20 mg. Citalopram been associated with abnormal heart rhythms and a mild
decrease in cognitive function. Some study participants who took citalopram
also reported anorexia, diarrhea, falls and upper-respiratory infections. Yet,
lower doses are still thought to be safer than antipsychotic drugs, which have
been associated with stroke, heart attack and death.
The study authors say
the next step is more research to determine whether the drug is as effective in
doses of 20 mg over a longer period. They also recommend that doctors assess
patients individually to determine drug doses, based on factors like the
patients' severity of agitation, cardiovascular health and cognitive function.
(Source: John Hopkins Health Alert, 30 June 2014)
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