The first-line of pharmacological treatment for the alleviation of severe agitation and psychotic symptoms of dementia is currently the second generation of antipsychotics, despite mounting scientific evidence that they can be associated with serious side effects–including death.
Currently the psychosis and agitation of younger patients with schizophrenia are treated with the same medications (antipsychotics) as older patients with dementia despite the suggestion that each group has a different neurochemistry.
A recent study published in the American Journal of Geriatric Psychiatry, is believed to be the first head-to-head comparison of an selective serotonin reuptake inhibitor (SSRI), citalopram, with one of the more commonly prescribed second generation antipsychotics, risperidone, used in the treatment of older, non-depressed dementia patients.
The 12-week study consisted of 103 patients hospitalized with psychiatric disturbances related to dementia. Approximately, half of the subjects were given daily doses of citalopram and the other half received daily doses of risperidone. Researchers were surprised to find that citalopram and risperidone had similar efficacy in reducing psychosis (hallucinations, delusions, suspicious thoughts) and agitation. Overall, there was a 32% reduction of symptoms with citalopram and a 35% reduction with risperidone. What is significant is that citalopram was associated with significantly less side effects, such as sedation, tension, and apathy.
Researchers did not expect that an antidepressant would have so-called antipsychotic properties. They also feel further trials, that includes a placebo group, needs to be done before anyone can feel confident that antidepressants are an effective and safe treatment for agitation and psychosis in patients suffering from dementia.