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Pharmacological interventions
Lack of clinically useful response predictors for treating aggression and agitation in Alzheimer's disease with citalopram
  1. Nathan Herrmann
  1. Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Ave, FG19, Toronto, ON M4N 3M5, Canada;

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ABSTRACT FROM: Schneider LS, Frangakis, C, Drye LT, et al. Heterogeneity of treatment response to citalopram for patients with Alzheimer's disease with aggression or agitation: the CitAD randomized clinical trial. Am J Psychiatry 2016;173:465–72.

What is already known on this topic

Neuropsychiatric symptoms (NPS) associated with Alzheimer's disease (AD) include depression, apathy, hallucinations, delusions, wandering and anxiety. Of all the NPS, agitation and aggression are among the most problematic and are associated with increased risk of mortality, earlier institutionalisation, increased cost of care and markedly increased caregiver burden. Over two dozen randomised placebo-controlled trials with a variety of atypical antipsychotics have demonstrated modest efficacy for agitation and aggression, with and without psychotic symptoms. Unfortunately, the use of atypical antipsychotics in patients with dementia is associated with an increased risk of cerebrovascular adverse events and mortality.1 As a result, clinical practice guidelines recommend their use only after environmental and behavioural interventions have been tried, and only when the behaviours represent a risk for harm to the patient and others.2 Because of this unfavourable risk/benefit ratio, …

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  • Funding NH has received research support from Lundbeck and Roche.

  • Competing interests NH has received consultation fees from Astellas, Merck and Lilly.

  • Provenance and peer review Commissioned; internally peer reviewed.