Antidepressant as Good as Antipsychotics for Dementia

MONDAY Sept. 10, 2007 -- 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.

Agitation and psychotic symptoms are often more disturbing than the memory loss associated with Alzheimer's and other forms of dementia and 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 often 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 Dr. Bruce Pollock, 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.

Pollock also noted that antipsychotic drugs have an increased risk of 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.

Pollock thinks the antidepressant worked, because the psychotic symptoms associated with dementia have a different chemistry than the same symptoms in a psychotic patient.

For the study, 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. Fifty-three patients received daily doses of citalopram, while 50 got daily doses of 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 percent reduction in symptoms among patients receiving citalopram, compared to a 35 percent reduction among those receiving risperidone.

However, there was a significant 19 percent increase in side effects with risperidone, compared with a 4 percent decrease among patients taking citalopram, the researchers reported.

Their findings are published in the Sept. 10 online edition of the American Journal of Geriatric Psychiatry.

If further studies replicate these findings, 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 percent of Alzheimer's patients will experience them. It's the phenomena that results in patients going to nursing homes and requiring higher levels of care."

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 Dr. Ralph A. Nixon, 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."

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.

"Based on these findings, we shouldn't go out there and replace the drugs that are the current standard with something where the jury is still out as to its efficacy," he said.

More information

For more on Alzheimer's disease, visit the Alzheimer's Association.

Posted: September 2007


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