People with Alzheimer’s disease often suffer from agitation but new research shows that the antidepressant drug, Celexa, could be effective at relieving these symptoms. “Agitation is one of the worst symptoms for patients and their families: it puts the Alzheimer’s patient at risk for other system overloads (cardiac, infection, etc.), wears them out physically, and exhausts caregivers and families,” noted one expert, Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City, who was not involved in the study. While antipsychotic drugs are used currently to treat agitation, there is also a higher risk of death in Alzheimer’s patients, so a safer alternative would be welcome, he said.
Led by Dr. Constantine Lyketsos, director of the Johns Hopkins Memory and Alzheimer’s Treatment Center in Baltimore, the new study included 186 Alzheimer’s patients with agitation symptoms such as emotional distress, aggression, irritability, and excessive movement. Researchers split them into two groups, where one group received increasing doses of the antidepressant drug citalopram, which is sold under the brand names Celexa and Cipramil, and also as generics. The other group took an inactive placebo.
Researchers found in the group taking the drug, agitation symptoms showed a significant decline. Around 40 percent of patients taking antidepressants had “considerable relief,” compared with 26 percent of those who took the placebo.
However, the drug was not without side effects. According to the study, patients taking the antidepressant were more likely to have slightly decreased mental function and abnormal heart function that increases the risk of heart attack. But current antipsychotics for agitation in Alzheimer’s patients also increase the risk of heart attack, perhaps even more so than citalopram, Lyketsos noted. They also increase the risk of stroke and death.
Researchers concluded that in smaller doses, citalopram might be safer than antipsychotic drugs. “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 in a Hopkins news release. “But here’s another medication choice that might be safer than other medications and seems to be just as effective.”
“The assessment of ‘benefit versus risk’ for the use of this or other medications needs to be made by families and physicians together on a ‘case by case’ basis,” Manevitz said. “Medications may certainly be necessary in the short term for acute care in many patients, and to stabilize the caregiving environment.”
Other researchers at Hopkins say the findings are not surprising. Dr. Theodore Strange, a geriatrician and associate chairman of the department of medicine at Staten Island University Hospital, in New York City, said, “The treatment of the effects of dementia, like depression and agitation, are fraught with their own side effects and therefore are of limited utility for many patients. Citalopram, an antidepressant, has some calming effects on agitation but again needs its own monitoring for side effects.”