Behandling med Citalopram vid demens. Normalisering av DST

Abstract

It is well-known that the concentration of serotonin is reduced in patients with dementia of Alzheimertype (AD/SDAT) as well as in patients with cerebral vascular diseases. Postmortem investigations have shown low concentrations of both 5-hydroxytryptamine (5-HT) and 5 hydroxyindoleacetic acid (5-HIAA). An emotional blunting as well as a decrease of the intellectual functions have been reported in patients with dementia. Patients with dementia are often depressed, anxious and irritable. Since a disturbance of serotonin and norepinephrine may influence the emotional reactions a treatment with Citalopram was conducted. Citalopram selectively blocks the re-uptake of 5-HT and it is thus assumed that the pharmacological effect is an activation of the rate of serotonin metabolism in the brain. In a pilot investigation where 20-30 mg Citalopram was given daily to patients with dementia, significant improvements were found in spontaneous activity, power to concentrate, distractibility, anxiety and nervousness. An inter-scandinavian study of the effects of Citalopram on dementia, using double-blind technique is running. Earlier studies of the dexamethasone suppression test (DST) have shown that patients with AD/SDAT as well as with cerebrovascular diseases showed abnormal lack of suppression. DST and samples of cerebrospinal fluid (CSF) for the determination of the levels of monoamine metabolites, were taken both before and after a two months treatment period with Citalopram. The results showed a significant reduction in CSF of 5-HIAA and 3-metoxy-4-hydroxyphenylglycol (HMPG). It is also interesting to note that there was a significant reduction of the level of postdexamethasone serum Cortisol concentrations after treatment with Citalopram.