A Cochrane review [Abstract] 1 included 9 RCTs with a total of 692 older adults with dementia. Five studies compared SSRIs to placebo and 3 studies to typical antipsychotics. The change in CMAI total score was significant between antidepressants and placebo on agitation (MD -0.89, 95% CI -1.22 to -0.57; 2 trials, n=126). Behavioral symptoms did not change significantly between SSRIs and placebo in the NPI and Behavioral Pathology in Dementia scales (1 trial, n=244). One study (n=85) on citalopram vs. placebo found a significant difference in NPS as measured on the Neurobehavioral Rating Scale (NBRS), although the unadjusted mean difference was not significant (MD - 7.70, 95% CI -16.57 to 1.17). There was no difference between SSRIs and placebo in the rates of trial withdrawals due to adverse events (RR 1.07, 95% CI: 0.55 to 2.11; 4 studies, n=399) or due to any cause (RR 0.91, 95% CI 0.65 to 1.26; 3 studies, n=343). There was no difference between citalopram and risperidone in NBRS scores, trial withdrawals due to any cause or adverse events, although the rates of adverse events as measured on the UKU side effect scale total score were lower for citalopram (MD -2.82, 95% CI -4.94 to -0.70; 1 study, n=103). In meta-analysis of 2 studies on SSRIs and typical antipsychotics there was no significant differences in changes in CMAI total scores (MD 4.66, 95% CI -3.58 to 12.90, n=38) or in trial withdrawals due to any cause or adverse events. In a trazodone vs. placebo study (n=73), no significant difference was found in change in CMAI total scores (MD 5.18, 95% CI -2.86 to 13.22) or trial withdrawals due to any cause (RR 1.06, 95% CI 0.54 to 2.09). There was no difference between trazodone and haloperidol in change in CMAI total scores (MD 3.28, 95% CI -3.28 to 9.85) or trial withdrawals due to any cause (RR 0.79, 95% CI 0.43 to 1.46; 2 studies, n=99).
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment), inconsistency (heterogeneity in outcomes) and imprecise results (limited study size for each comparison).
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