Using SSRIs to Treat Alzheimer’s Disease and Dementia Patients
What can recent research tell us about SSRIs and their effectiveness in treating various aspects of dementia and BPSD?
Alzheimer’s disease and related dementias (ADRD) affect a growing number of older people. The journal BMC Medical Informatics and Decision Making notes that the majority of dementia patients “face behavioural and psychological symptoms (BPSD) during the course of their illness.” (Joshi A et al.)
While medical science remains in search of more permanent remedies for ADRD, most contemporary treatments focus on helping to reduce BPSD and other adverse symptoms, while also pursuing therapies that may at least slow the progression of these neurological diseases.
How SSRIs can improve quality of life for dementia patients
Selective Serotonin Reuptake Inhibitors (SSRIs) have demonstrated promise in addressing a range of symptoms and underlying pathologies in Alzheimer’s disease and other types of dementia.
While these drugs are well known and classified as general antidepressants, their role in dementia care goes beyond treatment for anxiety and depression. The drug citalopram in particular has a number of beneficial uses, as demonstrated in recent scientific literature.
SSRI treatment for agitation in Alzheimer’s disease
According to the World Journal of Psychiatry, agitation in Alzheimer’s disease is described as “a neuropsychiatric syndrome characterized by excessive motor and/or verbal behaviors, with or without aggressive behaviors.”
The journal’s research places the number of Alzheimer’s disease patients with agitation at anywhere from five to fifty percent of all AD sufferers. (Teixeira AL et al.) The Journal of the Chinese Medical Association (JCMA) calls agitation “a frequently occurring and challenging neuropsychiatric symptom” that “substantially affects quality of life, caregiver burden, and healthcare utilization.” (Cheng CM et al.)
Findings published in Frontiers in Aging Neuroscience surveyed eight medical databases to assess the quality of different antidepressant drugs for treating agitation in dementia patients. Their research concluded that “among the antidepressant drugs included [in the study], treatment with citalopram was probably the only optimal intervention, when considering the improvement from baseline to the end of the intervention.”
Concerning any potential harmful side effects, the study found that “there was not a statistically significant difference in safety when compared with a placebo treatment.” (Chen K et al.)
In fact, patient safety is one of the key factors in prescribing citalopram for dementia-related agitation. The World journal of psychiatry notes that “for chronic agitation, serotonin-selective reuptake inhibitors, especially citalopram and escitalopram, are often preferred due to safety concerns associated with the long-term use of antipsychotics.” (Teixeira AL et al.) Narrative review published in the journal Pharmacy concurs, stating that “SSRIs such as citalopram were associated with a reduction in the symptoms of agitation, and lower risk of adverse effects when compared to antipsychotics.” (Qasim HS, Simpson MD.)
Using SSRIs to improve emotional stability in dementia patients
A study reviewed in International Clinical Psychopharmacology focused on SSRI treatment for patients with Alzheimer’s disease and vascular dementia. The study found that just four weeks of citalopram taken daily led to “significant improvement in confusion, irritability, anxiety, depressed mood and restlessness.” These findings led researchers to conclude that “citalopram is therefore considered not only an antidepressive drug but also an emotional stabilizer.” (Gottfries CG et al.)
SSRIs have been instrumental in treating symptoms in patients with frontotemporal dementia (FTD) as well. The European Journal of Neurology calls FTD “a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances.” The journal surveyed different drug treatments for FTD and found that “selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity.” (Wittebrood C et al.)
Can SSRIs help slow the progress of Alzheimer’s disease and dementia?
While SSRIs have been shown to alleviate Alzheimer’s disease and symptoms, the way these medications support the underlying health and chemistry of the brain may prove effective in fighting the disease itself.
Long-term SSRI treatment associated with slower progression of dementia
Recent research has yielded some positive insights into how SSRI use correlates to the progression of neurological disease. A study published in The American Journal of Geriatric Psychiatry found that “persistent use of SSRIs prior to death was associated with decreased progression of cognitive impairment.” (Shaw JS et al.)
While depression is acknowledged as a risk factor for dementia, prior inquiries into SSRIs and dementia risk have not always controlled for major depression in their data samples. The American Journal of Geriatric Psychiatry study focused on individuals with a documented lifelong history of depression as well as continued SSRI use over the study period.
Through survey of data from the National Alzheimer’s Coordinating Center, the study aimed to “identify associations between SSRI exposure in later life and cerebrovascular changes relevant to Vascular dementia on autopsy,” what the study refers to as “the gold standard of diagnosis.” Measuring against the Clinical Dementia Rating-Sum of Boxes (CDR-SB), the results showed that “continued SSRI use during later life was associated with a significantly slower increase on the CDR-SB compared to discontinuation of SSRIs.” (Shaw JS et al.) At the very least, this indicates that patients taking an SSRI for depression can and should continue its use without concern for their overall dementia risk.
Autopsy data also revealed additional positive outcomes for SSRIs. The study population with continued SSRI use demonstrated “a nearly 50% reduction of lacunes/infarcts on autopsy,” even after controlling for years of smoking and hypertension. Lacunes—small, fluid-filled brain cavities left after stroke or hemorrhage—and infarcts—regions of dead brain tissue created by sudden blood and oxygen deprivation—are pathological findings associated with dementia and BPSD. Their relative absence among SSRI users is a positive correlation that merits further study.
How SSRIs help promote proper function in the brain’s neurons
Researchers publishing in Translational Psychiatry studied the effects of citalopram on iPSC derived cortical neuronal cells. They concluded that “SSRIs may perturb AD progression, or the conversion from MCI [Mild Cognitive Impairment] to AD, via increased neurogenesis, reduced oxidative stress and/or favourable Amyloid-β Precursor Protein (AβPP) processing.” (Elsworthy RJ et al.)
Similar studies conducted on serotonergic, medullary raphe neurons (RN46A-B14) were published in Biochimica et Biophysica acta. Molecular Basis of Disease. This research concluded that “apart from its anti-depressive and anxiolytic effects, selective serotonin reuptake inhibitor (SSRI) treatment also offers intracellular modifications that may help to improve neurogenesis, reduce amyloid burden & Tau pathologies, and neuroinflammation in AD.” The study found that citalopram also “improved cell survival, mitochondrial respiration and mitochondrial morphology in the treated cells that express mAPP and mTau.” (Sawant N et al.)
GuideStar Eldercare can help improve quality of life for dementia patients
In partnering with long-term care facilities like yours, GuideStar Eldercare pursues a neurology-forward approach to dementia and BPSD. In addition to non-pharmacological treatment and intervention, we can help your facilities develop individualized treatment plans that incorporate the latest research into safe, effective SSRI usage, as well as other leading-edge drug treatments that can help patients with dementia enjoy enhanced quality of life. Contact us today to learn more about partnering with GuideStar Eldercare.