Researchers at Johns Hopkins have shown that a drug, Zoloft, commonly used for depression, also improves quality of life and alleviates disruption in daily activities for the one-quarter of Alzheimer's patients who also suffer from major depression. However, the drug did not improve patients' cognitive abilities, such as thinking, remembering and learning, which are often impaired in Alzheimer's disease patients. "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 and lead author of the report appearing in the July 2003 issue of the Archives of General Psychiatry.
The drug, called sertraline hydrochloride or Zoloft, is a common treatment for psychiatric diseases such as major depression, obsessive compulsive disorder and panic disorder.
Major depression affects 25 percent of patients with Alzheimer's disease, and when combined with the cognitive impairment of Alzheimer's, is extremely disabling and can lead to death or suicide, says Lyketsos.
"This simple and safe treatment for depression has tremendous potential for improving the quality of life for both Alzheimer's patients and their caregivers," said Lyketsos.
The study included adult participants with both Alzheimer's disease and major depression. All patients and their caregivers were educated about the illnesses and received encouragement and emotional support throughout the study. All patients were rated on a standardized depression scale and given a single placebo pill daily for one week in order to identify those with transient or temporary depression. Those patients with a drop of 30 percent or more in their depression scores were excluded from the study.
The remaining 44 patients were assigned randomly to receive placebo or sertraline once a day for 12 weeks. Patients were seen in the clinic every three weeks for 12 weeks following the study.
The results show that 84 percent of those receiving the drug were positively influenced, versus 35 percent in the placebo group. The researchers found that treating depression was accompanied by lessened behavioral disturbance and improved activities of daily living as well.
Based on the results, Lyketsos and his team are leading a multicenter clinical trial to investigate the long-term benefits of sertraline for patients with Alzheimer's and to determine how well the treatment eases the burden of caregivers.
According to the National Institute on Aging, up to 4 million Americans suffer from Alzheimer's disease. The disease usually begins after age 60, and risk goes up with age. While younger people also may get AD, it is much less common. About 3 percent of men and women ages 65 to 74 have AD, and nearly half of those age 85 and older may have the disease.
The study was funded by the National Institute of Mental Health. Other authors are Lourdes DelCampo, Martin Steinberg, Quincy Miles, Cynthia Steele, Cynthia Munro, Alva Baker, Jeannie-Marie Sheppard, Constantine Frangakis, Jason Brandt and Peter Rabins, all from Johns Hopkins.
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Dr. Lyketsos has been or is a consultant and advisor for the following companies: Astra-Zeneca Pharmaceuticals LP, E.I. duPont de Nemours and Company, Eli Lilly and Company, Janssen Pharmaceutica, NeuroLogic Inc, and Pfizer Inc. He has been or is a speaker for the following: Abbott Laboratories, Bayer Corporation, Bristol-Meyers-Squibb, E.I. duPont de Nemours and Company, Eisai Ltd, Forest Laboratories, Janssen Pharmaceutica, Novartis Pharmaceuticals USA, Parke-Davis (Warner-Lambert), and Pfizer Inc. He has received or receives research support from the following: Abbott Laboratories, Bayer Corporation, Bristol-Meyers-Squibb, Eisai Ltd, Eli Lilly and Company, Janssen Pharmaceutica, NeuroLogic Inc, Parke-Davis Company, and Pfizer Inc.
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