NIH-funded researchers are testing interventions to alleviate psychiatric conditions and symptoms, such as agitation, that distress people with Alzheimer’s and their caregivers. The goal is to identify treatments that are safer and more effective than the currently available antipsychotic drugs that are linked to increased risk for stroke and excessive sedation. Agitation, a syndrome that includes anxious, disruptive, or aggressive behavior, is common in the later stages of dementia and often leads to placing a loved one in residential care.
The online Feb. 19, 2014 Journal of the American Medical Association reported results from the NIH-supported Citalopram for Agitation in Alzheimer’s Disease Study (CitAD) clinical trial of the antidepressant citalopram (Celexa, Cipramil) as a possible treatment for Alzheimer’s agitation. Researchers from Johns Hopkins Bayview Medical Center, Baltimore, led the randomized, double-blinded trial involving 186 Alzheimer’s volunteers experiencing agitation. Ninety-four participants at eight sites in the United States and Canada received citalopram in dosages that gradually increased from 10 mg. to up to 30 mg. per day over 9 weeks; 92 participants received placebos. All the trial volunteers and their caregivers received psychosocial interventions, which included educational materials, supportive counseling, and care plans.
The results were intriguing. About 40 percent of the citalopram group showed significant improvement in agitation symptoms compared to 26 percent of those receiving the placebo. The caregivers of those receiving citalopram also reported feeling less stress. However, citalopram volunteers showed some decline in cognition and heart function. In light of the even greater heart health risks associated with antipsychotic treatments, the researchers concluded that citalopram, especially in lower doses, may be a more effective and safer alternative to treating agitation in Alzheimer’s patients.
Reference: Porsteinsson, A.P., et al. Effect of citalopram on agitation in Alzheimer’s disease: The CitAD randomized clinical trial.  JAMA. 2014 Feb. 19;311(7):682-91. doi:10.1001/jama.2014.93.