McCarrell Jamie L, Bailey Trista A, Duncan Nakia A, Covington Les P, Clifford Kalin M, Hall Ronald G, Blaszczyk Amie Taggart
Ment Health Clin. 2019 Jul 1;9(4):280-286. doi: 10.9740/mhc.2019.07.280. eCollection 2019 Jul.
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.
A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English.
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.
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.
神经精神疾病影响着数百万老年人。尽管如此，在评估精神疾病治疗方法的临床试验中纳入的老年人相对较少。西酞普兰已在患有神经精神疾病的老年人中进行了评估，并且在很大程度上被发现是有益的，这使得美国食品药品监督管理局（FDA）2011年关于西酞普兰的安全建议极具影响力。
使用PubMed数据库完成文献检索。结果仅限于在老年人中进行的、以英文发表的临床试验。
文献综述证实了西酞普兰在治疗抑郁症、焦虑症、与帕金森病相关的抑郁症以及痴呆症的行为和心理症状方面的疗效。此外，尚未有与西酞普兰相关的不良心脏结局的描述。
FDA将此安全建议应用于西酞普兰的证据极少，且主要基于替代指标，如QTc间期，而非临床和安全结局。已知西酞普兰会增加QTc，但这种增加并未与不良心脏结局相关联。疗效证据及无不良结局的证据表明，需要重新评估患有神经精神疾病的老年人的用药限制。
