September 10 : Canadian researchers say that they have found evidence that an antidepressant called citalopram is as effective in mitigating severe agitation and psychotic symptoms of dementia, as commonly-prescribed antipsychotic risperidone.

The researchers also say that the antidepressant is associated with “significantly lower” adverse side effects.

Published online in the American Journal of Geriatric Psychiatry, this 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 the elderly, say researchers.

However, they caution against any undue excitement before further studies replicate their early findings. According to them, second generation antipsychotics continue to be a first-line pharmacological treatment, despite growing scientific evidence that they can be associated with serious side effects, including death.

“We are 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 Dr. Bruce Pollock of the Rotman Research Institute at Baycrest, Toronto, who teamed up with colleague Dr. Benoit Mulsant of the Geriatric Mental Health Program at CAMH to conduct the study.

The researcher duo conducted a double-blind randomised control trial of citalopram (antidepressant) and risperidone (antipsychotic) to compare the efficacy and safety of the two drugs in 103 patients who were hospitalised with psychiatric disturbances related to dementia at the University of Pittsburgh Medical Centre.

In the 12-week clinical trial, 53 patients received daily doses of citalopram and 50 got daily doses of risperidone. Overall, 43 per cent of the participants completed the trial—47 per cent in the citalopram group and 40 per cent in the risperidone group.

Dr. Pollock said that the dropout rate was typical, and did not undermine the scientific validity of the findings.

He said that a comparison of the therapies showed that citalopram and risperidone had similar efficacy in reducing psychosis (hallucinations, delusions, suspicious thoughts) and agitation.

While citalopram therapy resulted in a 32 per cent reduction of symptoms, risperidone made for a 35 per cent reduction in the symptoms.

The researchers said that citalopram was associated with a significantly lower burden of adverse side effects, such as sedation, tension and apathy.

While total side effect burden scores increased 19 per cent for risperidone, it decreased by 4 per cent with citalopram.

“We didn’t expect that an antidepressant would have so-called antipsychotic properties. 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 (antipsychotics),” said Dr. Mulsant. (ANI)

Tags:Depression