July 24, 2003
Treating people with Alzheimer's disease who also suffer from depression with Zoloft, a popular antidepressant drug, may improve quality of life for both patients and caregivers alike, a new study shows.
"Depression in Alzheimer's patients, and even Alzheimer's disease itself, often goes undiagnosed, in part because doctors feel they have little to offer in the form of treatment. This study shows that a simple treatment for depression improves the quality of life and seems to slow the functional decline of Alzheimer's disease," says Constantine Lyketsos, M.D., professor of psychiatry and behavioral sciences at Johns Hopkins Medical Center and lead author of the report appearing in the July 2003 issue of the Archives of General Psychiatry.
Zoloft enhanced quality of life and eased disruptions of daily activities for many of the study participants who took it, with few serious side effects. Patients who received the drug were better able to carry out everyday activities like getting dressed and eating. They also showed fewer troubling behaviors, such as wandering and agitation. The researchers suspect that easing the depression in these patients led to modest improvements in behavior.
"This simple and safe treatment for depression has tremendous potential for improving the quality of life for both Alzheimer's patients and their caregivers," says Lyketsos.
Zoloft goes by the generic name sertraline hydrochloride and is closely related to antidepressants such as Prozac and Paxil. The doctors do not know if these or other antidepressants may offer additional benefits.
Easing the Caregiver Burden
About a fourth of people with Alzheimer's disease also suffer from depression, a condition that impairs their quality of life and can make them more aggressive, harder to care for and more likely to need nursing-home care. Alzheimer's patients also commonly suffer from other behavioral disturbances, such as agitation, insomnia, wandering and even hallucinations.
This trial looked at 44 people suffering from both Alzheimer's and serious depression. Half were given Zoloft once daily for 12 weeks, and the others were give a look-alike dummy pill. Patients and their caregivers were taught about the illness and received counseling and emotional support throughout the study.
Analysis revealed that 84 percent of those who received the antidepressant showed fewer behavioral problems and could better conduct their activities of daily living, compared to 35 percent of those receiving the dummy pill.
These findings bolster the results of several small earlier studies, which indicated that other antidepressant drugs can provide modest benefits to Alzheimer's patients suffering from depression. Non-drug therapies, including effective communication between caregivers and patients, have also been shown to help.
However, it is important to note that--as with all currently available drugs for Alzheimer's--improvements, if any, may be very subtle. In the current study, it took up to six weeks for benefits to take effect, and some patients who received the drug showed no improvement at all.
In addition, the antidepressant did not enhance the thinking, memory, or learning skills that deteriorate in Alzheimer's disease. Other drugs (Aricept, Exelon and Reminyl) are commonly prescribed for this purpose, and still others may be needed to combat aggressiveness, insomnia or other behavioral problems. None of these medicines do anything to halt or reverse the underlying processes of disease.
Still, the researchers stress that it is important for people with Alzheimer's to be evaluated by their doctors for underlying depression, since safe and effective treatments are readily available. Based on these encouraging results, they are planning a larger study to evaluate the long-term benefits of Zoloft and its effects on caregivers.
By Toby Bilanow, Medical Writer, www.ALZinfo.org. The Alzheimer’s Information Site. Reviewed by Samuel E. Gandy, M.D., Ph.D., Chairman of the Scientific Advisory Board, Fisher Center for Alzheimer's Research Foundation.