Citalopram Significantly Reduces Agitation in Patients with Alzheimer’s, Study Says

Psychological intervention paired with citalopram (brand names Celexa and Cipramil) therapy led to improvements in agitation and caregiver distress for patients with Alzheimer’s disease, according to a study published in the Journal of the American Medical Association. Experienced by patients with Alzheimer’s disease, agitation is “common, persistent, and associated with adverse consequences.” Treatment with pharmacological options such as antipsychotics has not been shown to be satisfactory.

A randomized, placebo-controlled, double-blind, parallel group trial encompassing 186 patients with probable Alzheimer’s disease was conducted between August 2009 and January 2013 in academic centers throughout the United States and Canada. The participants received psychological intervention plus either citalopram or a placebo for 9 weeks, with dosages of citalopram increasing over three weeks from 10 mg per day to 30 mg per day. The study analyzed the efficacy of citalopram (a selective serotonin reuptake inhibitor antidepressant used to treat major depression) for treating such agitation, as well as its effect on function, caregiver distress, safety, cognitive safety, and tolerability.

The participants in this study had probably Alzheimer’s disease, as determined by criteria developed by the National Institute of Neurological and Communication Disorders and Stroke-Alzheimer Disease and Related Disorders Association. The participants also had “clinically significant agitation,” for which a physician had deemed medication to be appropriate. Patients who had experienced major depressive episodes or psychosis requiring treatment with antispychotics were excluded.

Participants who had received citalopram experienced significant improvement over participants who had received a placebo. The results also showed improvements in caregiver distress. However, participants who had been treated with citalopram experienced greater cognitive worsening, as well as anorexia, diarrhea, and fever. Those treated with citalopram also experienced more frequent falls and adverse cardiac effects. Because of these effects, the researchers concluded that practical application may be limited to dosages of 30 mg per day, and that “[s]afe and effective treatments for agitation remain elusive and options are limited.”