Sertraline versus small doses of haloperidol in the treatment of agitated behavior in patients with dementia

Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review

“…The 29 studies meeting inclusion criteria encompassed 19 studies of antipsychotics (Barnes et al ., 1982; Cantillon et al ., 1996; De Deyn et al ., 1999; 2004; Katz et al ., 1999; Street et al ., 2000; Gaber et al ., 2001; Brodaty et al ., 2003; Fontaine et al ., 2003; Ballard et al ., 2005; Mintzer et al ., 2006; 2007; Tariot et al ., 2006; Verhey et al ., 2006; Holmes et al ., 2007; Huertas et al ., 2007; Zhong et al ., 2007; Streim et al ., 2008; Rappaport et al ., 2009) (15 studies of atypical antipsychotics (De Deyn et al ., 1999; 2004; Katz et al ., 1999; Street et al ., 2000; Brodaty et al ., 2003; Fontaine et al ., 2003; Ballard et al ., 2005; Mintzer et al ., 2006; 2007; Tariot et al ., 2006; Verhey et al ., 2006; Holmes et al ., 2007; Zhong et al ., 2007; Streim et al ., 2008; Rappaport et al ., 2009) and seven of typical antipsychotics (Barnes et al ., 1982; Cantillon et al ., 1996; De Deyn et al ., 1999; Gaber et al ., 2001; Tariot et al ., 2006; Verhey et al ., 2006; Huertas et al ., 2007)), three studies of cholinesterase inhibitors (Tariot et al ., 2001; Ballard et al ., 2005; Holmes et al ., 2007), four studies of anticonvulsants (Tariot et al ., 1998; 2005; Porsteinsson et al ., 2001; Sommer et al ., 2009), one study of antidepressants (Gaber et al ., 2001), and seven studies evaluating medications from other classes (Cantillon et al ., 1996; Kyomen et al ., 1999; Hall et al ., 2005; Peskind et al ., 2005; Huertas et al ., 2007; Gehrman et al ., 2009; Wang et al ., 2009) (Table 1). Of these studies, 20 were placebo-controlled (Barnes et al ., 1982; Tariot et al ., 1998; 2001; 2005; De Deyn et al ., 1999; …”

“…Of these studies, 20 were placebo-controlled (Barnes et al ., 1982; Tariot et al ., 1998; 2001; 2005; De Deyn et al ., 1999; 2004; Katz et al ., 1999; Kyomen et al ., 1999; Street et al ., 2000; Porsteinsson et al ., 2001; Brodaty et al ., 2003; Ballard et al ., 2005; Hall et al ., 2005; Peskind et al ., 2005; Mintzer et al ., 2006; 2007; Tariot et al ., 2006; Zhong et al ., 2007; Streim et al ., 2008; Gehrman et al ., 2009; Rappaport et al ., 2009; Sommer et al ., 2009; Wang et al ., 2009), and 11 compared two medications within the same trial (Barnes et al ., 1982; Cantillon et al ., 1996; De Deyn et al ., 1999; Gaber et al ., 2001; Fontaine et al ., 2003; Ballard et al ., 2005; Tariot et al ., 2006; Verhey et al ., 2006; Holmes et al ., 2007; Huertas et al ., 2007). All of the studies used oral formulations of medications except for one trial that utilized intramuscular aripiprazole (Rappaport et al ., 2009) and one study of transdermal estrogen (Hall et al ., 2005).…”

“…The median trial duration was 56 days (range = 1–90 days). A variety of outcome measures were reported in studies including composite measures of NPS (Barnes et al ., 1982; Cantillon et al ., 1996; Tariot et al ., 1998; 2001; 2005; 2006; De Deyn et al ., 1999; 2004; Katz et al ., 1999; Street et al ., 2000; Porsteinsson et al ., 2001; Fontaine et al ., 2003; Peskind et al ., 2005; Gehrman et al ., 2009; Sommer et al ., 2009; Wang et al ., 2009), agitation (Gaber et al ., 2001; Ballard et al ., 2005; Verhey et al ., 2006; Holmes et al ., 2007; Zhong et al ., 2007; Rappaport et al ., 2009,), aggression (Kyomen et al ., 1999; Brodaty et al ., 2003; Hall et al ., 2005; Huertas et al ., 2007), or psychosis (Mintzer et al ., 2006; 2007; Streim et al ., 2008). …”

Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial

“…Our findings are supported by previous randomised controlled trials on the effect of antidepressants on neuropsychiatric symptoms of dementia in patients with Alzheimer's disease, which have shown a benefit of antidepressants over placebo on emotional bluntness, anxiety, depressive mood, and restlessness; 27 a favourable effect on behavioural symptoms; 6 and a decreased frequency of irritability and apathy. 28 Previous trials have also shown antidepressants to be as effective in reducing agitation in dementia as haloperidol, 29 and to have a similar effect on behavioural symptoms and psychosis as risperidone. 30 Nevertheless, both meta-analyses and systematic reviews have concluded that little evidence is available to show the effectiveness of antidepressants on neuropsychiatric symptoms.…”

Current management tactics for patients with dementia

“…Важно помнить, что цита-лопрам должен быть исключен при высоком риске возник-новения аритмии (увеличение интервала QT на электрокар-диограмме -ЭКГ, гипокалиемия, снижение уровня магния, развитие сердечной недостаточности) [20][21][22]. В 2011 г. был проведен систематический анализ 9 рандомизированных контролируемых исследований, в которых изучали влияние антидепрессантов на нейропсихиатрические симптомы [21,23,24]. Из них в пяти сравнивали действие СИОЗС (цитало-прам, сертралин, флуоксетин, флувоксамин) и плацебо, и только в одном исследовании было показано преимущество циталопрама перед остальными препаратами в уменьшении нейропсихиатрических проявлений.…”