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Dec. 19 - Antidepressant Shows Promise As Dementia Antipsychotic

Researchers have found evidence that the antidepressant citalopram may perform as well as risperidone, a commonly-prescribed antipsychotic in the alleviation of severe agitation and psychotic symptoms of dementia. The antidepressant also showed “significantly lower” adverse side effects.

The study, published in the online American Journal of Geriatric Psychiatry, is believed to be the first head-to-head comparison of an SSRI (selective serotonin reuptake inhibitor) with one of the more commonly prescribed second generation antipsychotics in older, non-depressed patients. The findings raise the possibility of a new direction in drug treatment for psychotic disorders related to dementia in older adults.

However, researchers caution that more studies are needed to replicate their early findings. “We’re encouraged by this early data, but we need to learn more in further trials that include a placebo group before we can say with confidence that antidepressants are an effective and safe treatment for agitation and psychosis in patients suffering from dementia,” says lead investigator Bruce Pollock, MD, who teamed with Benoit Mulsant, MD, for the study. Both are with the Geriatric Mental Health program at the Centre for Addiction and Mental Health in Toronto. They conducted a double-blind randomized control trial of citalopram and risperidone to compare the efficacy and safety of the two drugs in 103 patients who were hospitalized with psychiatric disturbances related to dementia at the University of Pittsburgh Medical Centre.

In the 12-week trial, 53 patients were given daily doses of citalopram and 50, daily doses of risperidone. Overall, 43% of the participants completed the trial: 47% in the citalopram group and 40% in the risperidone group. It was found that citalopram and risperidone had similar efficacy in reducing psychosis and agitation. Overall, there was a 32% reduction of symptoms with citalopram and 35% with risperidone. Total side effect burden scores increased 19% for risperidone and decreased by 4% with citalopram.
Mulsant notes, “It reinforces our belief that psychosis and agitation have a different neurochemistry in older patients with dementia and in younger patients with schizophrenia, even though both groups of patients are currently treated with the same medications.”

Source: Baycrest Centre for Geriatric Care