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Citalopram reduced agitation, led to cognitive worsening in Alzheimer’s disease

Recent data show citalopram treatment reduced agitation among patients with Alzheimer’s disease, although a dosage of 30 mg per day caused mild cognitive and cardiac adverse effects.

Anton P. Porsteinsson, MD, of the University of Rochester, and colleagues conducted a randomized, placebo-controlled study of 186 patients with probable Alzheimer’s disease without major depression and clinically significant agitation. The mean age of the study participants was 78 years, and they were diagnosed with dementia at least 5 years before the study. Patients received psychological counseling and citalopram (n=94) or placebo (n=92) for 9 weeks. Dosage began at 10 mg per day with a planned titration to 30 mg per day during 3 weeks based on tolerability.

Study results showed that 40% of patients assigned citalopram significantly improved in terms of agitation vs. 26% of patients in the placebo group. Cognitive worsening and QT interval prolongation were observed in patients assigned citalopram, suggesting that a dosage of 30 mg per day causes adverse effects.

“Although citalopram at 30 mg daily was associated with clinically meaningful reduction in agitation in patients with Alzheimer’s disease … citalopram showed mild cognitive and concerning cardiac adverse effects and cannot be generally recommended as an alternative treatment at that dose,” Porsteinsson and colleagues concluded. “An assessment of individual patient circumstances, including symptom severity, value of improvement, cognitive function and change, cardiac conduction, vulnerability to adverse effects, and effectiveness of behavioral interventions can help guide appropriate medication use in patients with marked agitation or aggression.”

Disclosure: For a full list of financial disclosures, see the study.