Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Citalopram in Patients with Alzheimer Disease

Use should be limited to certain patients

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