Relax — New Treatment for Alzheimer's Agitation

Citalopram may be effective treatment for Alzheimer agitation

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Patients with Alzheimer’s disease sometimes have severe agitation that needs to be managed with medication. A new study found that one medication could be a good treatment.

Changes in behavior are typical of Alzheimer's disease. Alzheimer's patients may feel anxious, stressed or agitated and may be easily irritated.

Normally symptoms related to agitation are treated with the use of antipsychotic medications. However, this new study found that citalopram (brand name Celexa) may be a safer alternative.

The researchers reported that patients who took citalopram for nine weeks greatly improved their agitation symptoms.

"Tell your doctor if you're experiencing agitation from Alzheimer's."

This clinical trial was led by Anton Porsteinsson, MD, from the Department of Psychiatry at the University of Rochester. The aim of the trial was to investigate the efficacy and safety of citalopram to treat agitation in Alzheimer's patients.

This trial used data on 186 patients from the United States and Canada. The participants were adults, about 78 years of age, who were diagnosed with probable Alzheimer's disease and agitation symptoms.

These participants were randomly assigned to one of two treatment groups. The treatments given to each group included psychosocial intervention in addition to the following:

  • Citalopram for nine weeks, starting with 10 milligrams per day of citalopram and gradually increasing the dose to 30 mg in a three-week period.
  • Placebo (fake medicine) for nine weeks.

This was a double-blind trial, meaning that neither the participants nor the doctors who evaluated the participants knew which treatment was given to each person.

Improvement among the participants was measured and compared using standard tests commonly used by physicians. These tests included the Neurobehavioral Rating Scale-Agitation (NBRS-A) and the Alzheimer's Disease Cooperative Study Clinical Global Impression of Change in Agitation (ADCS-CGIC).

In both tests, participants taking citalopram showed marked improvement compared to those taking placebo.

NBRS-A scores vary from 0 to 18, with a higher score indicating more severe agitation symptoms. After nine weeks, patients in the citalopram group had less agitation (score of 4.3) than patients in the placebo group (score of 5.26).

When the participants were evaluated using the ADCS-CSGIC test, the researchers found that 40 percent of the participants in the citalopram group showed an improvement, compared with 26 percent of the placebo group.

However, the researchers also reported negative effects from taking citalopram. The study showed that patients taking citalopram had faster cognitive decline and more falls, abnormal electrocardiograms, anorexia, diarrhea, fever, gastrointestinal complains and upper respiratory tract infections than those who did not take the medication.

In future studies, these researchers plan to investigate whether lower doses of citalopram can decrease the negative effects of the medication.

Presently, physicians usually prescribe antipsychotic medications to control agitation in Alzheimer's patients despite serious side effects of antipsychotics.

Steve Leuck, PharmD, president and owner of AudibleRx, told dailyRx News about the health risks associated with using antipsychotics medications in the elderly. “Anti psychotic medications have a Black Box Warning, cautioning against their use in the treatment of elderly patients with dementia related psychosis," said Dr Leuck. "In this category of patients, these medications have been shown to increase the chance of cardiovascular or infection-related death.”

Study co-author Constantine Lyketsos, MD, MHS, said, “If the agitation is not responding to non-medication treatments and your patient’s agitation isn’t improving, there are no great options. But here’s another medication choice that might be safer than other medications and seems to be just as effective.”

This study was published on February 18 in JAMA and was funded by the National Institute on Aging and National Institute of Mental Health.

Review Date: 
February 16, 2014
Last Updated:
February 20, 2014