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SSRI Comparable to Antipsychotic for Psychosis in Dementia

(PSYCHIATRIC TIMES) - TORONTO, Sept. 10 -- An antidepressant may be just as effective as an antipsychotic for calming agitation and treating psychotic symptoms in older patients with dementia, investigators here reported.In a small study comparing the selective serotonin reuptake inhibitor citalopram (Celexa) with the antipsychotic risperdone (Risperdal), the efficacy of the SSRI was comparable at relieving psychotic symptoms, with fewer adverse events, reported Bruce G. Pollock, M.D., Ph.D., of the University of Toronto, and colleagues.

"Contrary to our hypothesis and conventional beliefs that an antipsychotic would be superior for the treatment of psychotic symptoms, a similar improvement was observed with both citalopram (-32.3%) and risperidone

(-35.2%)," the authors wrote in an early online release from the November issue of the American Journal of Geriatric Psychiatry,

Fewer than half of the patients continued the 12-week trial, however, a finding that highlights the difficulties of pharmacotherapy in a frail population, the authors said.

Although current guidelines recommend the use of atypical antipsychotics such as risperidone for pharmacologic treatment of non-cognitive symptoms of dementia such as agitation or psychosis, "there are concerns regarding both their safety and effectiveness in patients with dementia," they wrote. "Sparse and inconclusive evidence support the use of alternative agents such as antidepressants or cognitive enhancers."

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