Antidepressant Drug May Relieve Dementia Symptoms
NEW YORK (Reuters Health) - In a head-to-head trial, the antidepressant drug citalopram (Celexa) performed as well as the antipsychotic drug risperidone (Risperdal) in alleviating symptoms of agitation and psychosis that can be associated with dementia.
Wednesday, September 26, 2007
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NEW YORK (Reuters Health) - In a head-to-head trial, the antidepressant drug citalopram (Celexa) surprised researchers by performing as well as the antipsychotic drug risperidone (Risperdal) in alleviating symptoms of agitation and psychosis that can be associated with dementia, while also offering a significant reduction in drug side effects.
The trial, which was conducted from February 2000 to June 2005 at the University of Pittsburgh Medical Center, enrolled 103 consecutive inpatients who had at least one of the following symptoms: aggression, agitation, hostility, suspiciousness, hallucinations or delusions. The majority - 86 patients -- were diagnosed with Alzheimer's dementia.
Lead author Dr. Bruce G. Pollock, now at the University of Toronto, and colleagues randomly assigned the patients to receive either citalopram or risperidone for 12 weeks, beginning with one capsule (10 mg of citalopram or 0.5 mg of risperidone) per day for 3 days, followed by at least 2 weeks of 2 capsules per day. Two more dose increases were permitted, which was determined by patient response and side effects.
Based on their previous work, the researchers had hypothesized that risperidone would be more effective against psychosis, and that citalopram, a selective serotonin reuptake inhibitor, would be more effective against agitation. Citalopram exceeded these expectations, however.
Assessment of the patients at the beginning of the study and at least biweekly during the 12-week trial showed that changes in agitation and psychosis did not differ significantly between the two groups.
Patients in both groups showed a statistically significant difference in levels of sedation or drowsiness, with citalopram causing a decrease and risperidone causing an increase, according to the report, which is published online in the American Journal of Geriatric Psychiatry.
The researchers caution that the trial's relatively small size and short duration prevent them from drawing firm conclusions about the relative safety of citalopram and risperidone.
They do conclude, however, that "the overall burden of side effects and in particular 'psychic' side effects (including sedation, tension and apathy) were significantly lower with citalopram."
If similar results are obtained from larger placebo-controlled multicenter trials, a selective serotonergic antidepressant drug may become the first choice of treatment for these patients, especially because of the "black box" warning of potentially serious side effects of the atypical antipsychotic drugs, Pollock told Reuters Health.
SOURCE: American Journal of Geriatric Psychiatry 2007.
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