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McCarrell JL, Bailey TA, Duncan NA, et al. A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults. Ment Health Clin. 2019;9(4):280-286doi: 10.9740/mhc.2019.07.280.
McCarrell, J. L., Bailey, T. A., Duncan, N. A., Covington, L. P., Clifford, K. M., Hall, R. G., & Blaszczyk, A. T. (2019). A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults. The mental health clinician, 9(4), 280-286. https://doi.org/10.9740/mhc.2019.07.280
McCarrell, Jamie L, et al. "A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults." The mental health clinician vol. 9,4 (2019): 280-286. doi: https://doi.org/10.9740/mhc.2019.07.280
McCarrell JL, Bailey TA, Duncan NA, Covington LP, Clifford KM, Hall RG, Blaszczyk AT. A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults. Ment Health Clin. 2019 Jul 01;9(4):280-286. doi: 10.9740/mhc.2019.07.280. eCollection 2019 Jul. PMID: 31293848; PMCID: PMC6607952.
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Ment Health Clin. 2019 Jul 01;9(4):280-286. doi: 10.9740/mhc.2019.07.280. eCollection 2019 Jul.

A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults.

The mental health clinician

Jamie L McCarrell, Trista A Bailey, Nakia A Duncan, Les P Covington, Kalin M Clifford, Ronald G Hall, Amie Taggart Blaszczyk

PMID: 31293848 PMCID: PMC6607952 DOI: 10.9740/mhc.2019.07.280

Abstract

INTRODUCTION: Neuropsychiatric disorders affect millions of older adults. Despite this, there are relatively few older adults included in clinical trials evaluating treatments for psychiatric disorders. Citalopram has been evaluated in older adults with neuropsychiatric disorders and has largely been found beneficial, making the 2011 US Food and Drug Administration (FDA) safety advisory on citalopram extremely impactful.

METHODS: A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English.

RESULTS: Review of the literature confirms the efficacy of citalopram in depression, anxiety, depression associated with Parkinson disease, and behavioral and psychological symptoms of dementia. Additionally, no adverse cardiac outcomes have been described related to citalopram.

DISCUSSION: The FDA's evidence for applying this safety advisory to citalopram is minimal and largely based on surrogate markers, such as the QTc interval rather than clinical and safety outcomes. Citalopram is known to increase the QTc, but this increase has not been linked to adverse cardiac outcomes. The evidence for efficacy and against adverse outcomes suggests that a reevaluation of the dosing restrictions in older adults with neuropsychiatric disorders is needed.

Keywords: Food and Drug Administration (FDA); anxiety; behavioral and psychological symptoms of dementia (BPSD); citalopram; depression; neuropsychiatric disorders; safety

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