Individuals with moderate agitation and lower levels of cognitive impairment are more likely to benefit from citalopram, according to a double-blind, parallel-group multicenter trial of 186 patients with Alzheimer disease and agitation. Conversely, those with more severe agitation and greater cognitive impairment have a higher risk for adverse responses.
Participants were randomly assigned to take citalopram or placebo for 9 weeks. Investigators grouped patients into 10 subgroups and estimated the effect of citalopram in each group.
Among the results:
• Those who responded to citalopram were more likely to be outpatients, have the least cognitive impairment, have moderate agitation, and range between 76 and 82 years of age.
• Placebo-responsive patients were more likely to be in long-term care, have more severe cognitive impairment, have more serious agitation, and be treated with lorazepam.
The authors concluded that it may be best to limit citalopram for agitation to a subgroup of patients with dementia, especially considering the drug’s association with cardiac QT prolongation.
Citation: Schneider L, Frangakis C, Drye L, et al. Heterogeneity of treatment response to citalopram for patients with Alzheimer’s disease with aggression or agitation: The CITAD randomized clinical trial. [Published online ahead of print January 15, 2016] Am J Psychiatry. doi: http://dx.doi.org/10.1176/appi.ajp.2015.15050648