Patients with Alzheimer’s may find relief from their agitation in a popular antidepressant drug, a new study published in the Journal of the American Medical Association (JAMA) suggests.
Citalopram — better known on the market as Celexa — reduced agitation in a group of Alzheimer’s patients in a study by researchers at John Hopkins University in collaboration with several other institutions. The researchers say citalopram may be safer than the antipsychotic drugs currently used to treat agitation, though both treatments increase the risk for heart failure. In a news release, study author Kostas Lyketsos defines citalopram as a viable alternative, calling it “another medication choice that might be safer than other medications and seems to be just as effective.”
When Alzheimer’s patients experience agitation, they often feel anxious, emotionally distressed, physically restless, and irritable. Agitation can also translate to sleep disturbances, hallucinations, and the patient’s inability to follow a daily routine. For the patients in this study, antipsychotics failed to reduce their distress. Non-medical treatments — which include changing a patient’s environment — also provided no relief.
For the study, the researchers divided 186 Alzheimer’s patients into two groups, giving half citalopram and the rest placebo. After nine weeks, patients were said to have “significant relief from their agitation symptoms,” according to the news release. Forty percent of citalopram patients felt reduced agitation in comparison to 26 percent of patients taking a placebo.
“I think that citalopram is now a valuable option to physicians seeking to treat agitation in their Alzheimer’s patients with a medication,” Lyketsos told Medical Daily in an email. “Already the use of citalopram for this purpose has increased and I anticipate further increase.”
Nevertheless, Lyketsos warns against the citalopram’s apparent disadvantages. Before the trial, all patients took a cognitive test that measured their memory and cognitive skills. When the patients were tested again after taking citalopram, the researchers found that patients taking the antidepressant showed a slight decrease in cognitive function. Lyketsos called the decrease “not huge, but measurable”, adding that the slight cognitive decline “introduces a tradeoff.”
“Doctors must be cautious about dosing and safety monitoring due to the cardiac and other adverse effects,” says Lyketsos. “We are hoping that future research will better clarify which subgroup of Alzheimer patients will most benefit from the use of citalopram.”
Cognitive decline wasn’t the only consequence of citalopram. The study reports that the citalopram patients showed increased risks for having a heart attack. The patients exhibited longer QTc intervals — or abnormal heart patterns as measured by an electrocardiogram. Electrocardiograms detect the electrical activity of the heart. But while it makes citalopram potentially dangerous, the risk for heart failure also accompanies agitation’s alternative treatment: antipsychotics.
For years, researchers have reported the heart risks associated with antipsychotics. A 2009 study and accompanying editorial published in The New England Journal of Medicine warned that prescriptions of antipsychotics like Seroquel and Zyprexa should be reduced, especially among the elderly. The study showed that people who used typical and atypical antipsychotics were at a higher risk for sudden cardiac death compared to people who didn’t use antipsychotics at all.
According to Lyketsos, antidepressants like citalopram may not be as dangerous for the heart as antipsychotics. For now, citalopram appears to sit as an alternative treatment for agitation. In the future, Lyketsos and his team want to investigate whether lower doses of citalopram will treat agitation but keep the risk for heart failure and cognitive decline low.
Source: Porsteinsson A, Drye L, Pollock B, et al. Effect of Citalopram on Agitation in Alzheimer Disease, The CitAD Randomized Clinical Trial. JAMA 2014.