Study: Antidepressant Aids Alzheimer’s Agitation

Study: Antidepressant Aids Alzheimer’s Agitation

Posted on February 26, 2014 by ElderCare Resources Phoenix in Alzheimers Care, Blog, Caregiver Education, Dementia Care, Education, Geriatric Care Management, Long Term Care Information, Memory Loss

By: Patti Singer, Staff writer – Democrat and Chronicle

When a person with Alzheimer’s is agitated, so is their caregiver.

“You can’t ask them, ‘What is bothering you?’ ” said Mary Webb of Rochester, whose younger brother has the disease. “At that point they’re beyond where you can communicate with them. We don’t know what to do. You try everything you think of to do, but you’re guessing.”

Agitation affects about one-quarter of people with Alzheimer’s and is a major source of caregiver burnout, said Dr. Anton P. Porsteinsson, director of the Alzheimer’s Disease Care, Research and Education Program at the University of Rochester School of Medicine and Dentistry.

He said options are limited, and some drug therapies had serious side effects.

Porsteinsson led research that found the commonly prescribed antidepressant citalopram could quell agitation without the serious side effects of other medications that have been used.

Citalopram is sold under the brand names Celexa and Cipramil. Porsteinsson said it was being investigated as an alternative to antipsychotics, which he said have been linked to increased risk of death from a variety of causes.

The study, which took place at eight academic medical centers in the U.S. and Canada, was published online Tuesday in the Journal of the American Medical Association. Rochester residents participated in the research.

While Porsteinsson said the results were promising, he acknowledged more work is needed. The study was moderate in size — it enrolled 186 people and about 170 completed the nine-week regimen. More than halfway through, the Food and Drug Administration recommended a lower dose than was used in the study. Porsteinsson said a new study will have to see whether that lower amount gets the same results.

The study did not address how Alzheimer’s affects cognition. “That’s a whole different story,” Porsteinsson said. “This is focusing on one type of distress and behavioral disruption.”

In that context, “This is a nice step forward,” Porsteinsson said.

Nationally, one in nine Americans age 65 and older has Alzheimer’s disease, and 320,000 in New York state, according to the Alzheimer’s Association.

Study participants were randomly assigned to a group that received citalopram or a group that received a placebo. Everyone in the study took part in a program that provided education, 24-hour crisis management and counseling sessions.

“We tried to work with both the patient and the caregiver about what’s going on,” said Porsteinsson, who also is a professor of psychiatry.

The irritability, opposition and aggressiveness shown by an agitated patient aren’t spiteful, but are a consequence of the disease, he said. Nevertheless, the relationship between patient and caregiver can suffer.

Porsteinsson said all study participants responded well, but the group receiving citalopram did markedly better —without leaving them sedated.

“This would definitely be a big improvement,” Webb said. “This would be something that would calm him down without putting him to sleep.”

It also could help her. She said her brother doesn’t recognize family, and he doesn’t always welcome their help. She said staff members where he lives have warned that he could strike out when agitated.

“I don’t think he’d hit me,” she said. “It’s harder for a caregiver to settle down someone they’ve been around their whole life.

“But he’s not him anymore.”

Published:  Democrat and Chronicle