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Antidepressants To Treat Dementia: How Can They Help?

“Wow, Celexa?”

“Yeah, who knew?”

I overheard this conversation in the ladies’ room immediately after a session speaker advised treating agitation and aggression in dementia with citalopram. Indeed, there was a bit of a murmur in the audience when Dr. Aleta Borrud made the suggestion during her talk at the Mayo Update in Hospital Medicine 2011 course.

Part of the reason for the reaction may be– as a physician I spoke with noted– that the FDA recently told clinicians not to use the drug above 40 mg because it can prolong the QT interval. But, he quickly added, the doses used in dementia would be lower.

Dr. Borrud said there is no single set of recommendations for treating agitation/aggression in dementia…but she has done a lot of research on the topic, and recommends the following (which is what the psychiatrists at Mayo Clinic do, she said):

–First, try citalopram (“Not [sertraline], which can increase energy,” where citalopram doesn’t, Dr. Borrud said.)

–Then, try cholinesterase inhibitors.

–Then, try 3 mg of melatonin at bedtime to restore the sleep/wake cycle.

–Then, try a mood stabilizer (divalproex sprinkles) “if you are at your wit’s end”)

–Then, as the last resort, try antipsychotics. A September JAMA study (Maher et al) suggests aripiprazole (trade name Abilify) as the first one to try, or risperidone.

So what about haloperidol, anyway? Only works against aggression—not agitation, Dr. Borrud said.

*This blog post was originally published at ACP Hospitalist*


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