The antidepressant citalopram Celexa) may be as effective as often-prescribed antipsychotic drugs to control the agitation and psychotic symptoms associated with dementia, a new study suggests.
Background
Agitation and psychotic symptoms are often more disturbing than the memory loss associated with Alzheimer's and other forms of dementia. They are also the most difficult challenge for family members caring for an elderly person. Currently, antipsychotic drugs such as risperidone (Risperdal) are used to control these symptoms. But the side effects, including sedation, tension and apathy, can be debilitating, the study authors said.
"We found that an antidepressant worked as well in severely agitated patients suffering from Alzheimer's disease as an antipsychotic," said lead researcher Bruce Pollock, MD, of the University of Toronto's department of psychiatry. "And citalopram had fewer side effects.
The surprise was that citalopram worked as well for psychotic symptoms such as delusion and visual hallucinations, he said.
The Study
Dr. Pollock's team randomly assigned 103 patients who were hospitalized at the University of Pittsburgh Medical Center with psychiatric disturbances related to dementia to receive either citalopram or risperidone.
After 12 weeks, the researchers found that both drugs had a similar effect in relieving psychotic symptoms, such as hallucinations, delusions and suspicious thoughts. There was a 32% reduction in symptoms among patients receiving citalopram, compared to a 35% reduction among those receiving risperidone.
However, there was a significant 19% increase in side effects among patients taking risperidone, compared with a 4% decrease with citalopram, the researchers reported.
Implications
If further studies replicate these findings, Dr. Pollock thinks antidepressants could be a viable alternative to antipsychotic drugs for Alzheimer's patients.
"Behavioral disturbances are the most terrible thing that patients and caregivers have to cope with in dementia," he said. "And 90% of Alzheimer's patients will experience them. It's the phenomenon that results in patients going to nursing homes and requiring higher levels of care."
Pollock also said that antipsychotic drugs have an increased risk for death associated with their use. "But, for the first time, it has been shown that an antidepressant may work as well for psychotic symptoms as an antipsychotic," he said.
One expert thinks these findings are promising but need to be confirmed before they can be put into clinical practice.
"This is an interesting direction for further research," said Ralph A. Nixon, MD, PhD, a professor of psychiatry and cell biology at New York University School of Medicine and a member of the Alzheimer's Association's medical and scientific advisory council. "It is a preliminary indication of a new class of medications to treat something that has been a very vexing problem to treat."
Dr. Nixon thinks these drugs need to be compared with placebos to gauge the true effect of antidepressants on the psychotic symptoms associated with Alzheimer's.
