Major Neurocognitive disorders with behavioral disturbance are commonly referred for psychiatric consultation. The use of anti-psychotics as a treatment modality in this population is highly scrutinized given increased risk of mortality in the elderly. Efficacy of Selective Serotonin Reuptake Inhibitors (SSRIs) in improvement of behavioral disturbance has been shown in Alzheimer's type neurodegenerative disease (Auchus AP, Bissey-Black C., 1997; Anton, P, et al., 2014). SSRIs (sertraline and citalopram) were associated with a reduction in symptoms of agitation when compared to placebo (Seitz DP, Adunuri N, Gill SS, et al., 2011). The use of sertraline for behavioral issues related to neurodegenerative etiology other than Alzheimer's Dementia has not been actively researched. We describe use of sertraline in a case of behavioral disturbances secondary to Vascular Cognitive Impairment (VCI). Our treatment approach of rapid titration of sertraline by 50 mg daily reaching a target dose of 200 mg demonstrated marked improvement in mentation/mood/behavior. The application of SSRIs for treatment of behavioral disturbance in neurodegenerative disease warrants further study. Comparable to anti-psychotics in efficacy and tolerance, as described in treatment of Alzheimer's with behavioral changes, SSRIs could serve as an alternate treatment to anti-psychotics which are commonly used in current practice.
Additional Resource: Anton P Porsteinsson; Lea T Drye; Bruce G Pollock; D P Devanand; Constantine Frangakis; Zahinoor Ismail; Christopher Marano; Curtis L Meinert; Jacobo E Mintzer; Cynthia A Munro; Gregory Pelton; Peter V Rabins; Paul B Rosenberg; Lon S Schneider; David M Shade; Daniel Weintraub; Jerome Yesavage; Constantine G Lyketsos;, JAMA : the journal of the American Medical Association. , 2014, Vol.311(7), p.682