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Citalopram for Alzheimer’s disease requires further research

Although citalopram appeared to reduce delusions, anxiety and irritability among individuals with Alzheimer’s disease, researchers expressed concern regarding cognitive and cardiac side effects of the treatment.

“No pharmacotherapy has been approved for this indication by the [FDA]. Atypical antipsychotics, which have the best-established albeit limited efficacy, are the most frequently used agents in practice. This is problematic, as growing evidence suggests serious safety concerns, increased mortality, and uncertain efficacy when using antipsychotics in patients with dementia,” Anne K. Leonpacher, MD, of Johns Hopkins University School of Medicine, Baltimore, and colleagues wrote.

As secondary analysis of the Citalopram for Agitation in Alzheimer’s Disease study, researchers assessed citalopram across 12 neuropsychiatric symptom domains on the Neuropsychiatric Inventory. Caregiver reports were compared at week 9 for study participants receiving 30 mg per day of citalopram or placebo who exhibited symptoms at that time.

Participants receiving citalopram were significantly less likely to be reported as exhibiting delusions (OR = 0.4), anxiety (OR = 0.43) and irritability/lability (OR = 0.38).

Citalopram was more effective for hallucinations, while placebo was more effective for sleep/nighttime behavior disorders, according to a comparison of median scores among participants who exhibited symptoms at week 9.

“Citalopram at a dosage of 30 mg/day shows efficacy for the treatment of agitation and appears to be similarly effective for a broad range of concomitant neuropsychiatric symptoms, particularly delusions, anxiety and irritability/lability,” the researchers wrote. “While citalopram is a therapeutic option for the treatment of agitation in Alzheimer’s disease even when psychotic symptoms are present, the concerning side effects of cognitive worsening and delayed cardiac repolarization seen in this study as well as safety concerns with depressed elderly patients, urge dosage constraints and caution.” – by Amanda Oldt

Disclosure: Leonpacher reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.