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[P4–004]: THE COMBINATION OF CITALOPRAM AND RIVASTIGMINE IN THE TREATMENT OF MOOD DISORDER AND COGNITIVE IMPAIRMENT DUE TO CEREBROVASCULAR DISEASE: A CASE REPORT AND LITERATURE REVIEW
Author(s) -
BarcelosFerreira Ricardo,
Steffens David C.,
Folquitto Jefferson Cuhna,
Filho Geraldo Busatto,
Correa de Toledo Ferraz Alves Tania,
Machado de Campos Bottino Cassio
Publication year - 2017
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2017.06.1868
Subject(s) - rivastigmine , citalopram , mood , psychiatry , major depressive disorder , depression (economics) , medicine , adverse effect , psychology , escitalopram , clinical psychology , pediatrics , disease , dementia , antidepressant , anxiety , donepezil , macroeconomics , economics
Background: Although common, mood disorder due to cerebrovascular disease is rarely diagnosed by general practitioners, despite this condition being associated with poor health outcomes and increased mortality risk in the elderly. Methods: In this case report, we sought to characterize the clinical course of a 67-year-old man with mood symptoms associated with cerebrovascular disease, treated with a combination of the selective serotonin reuptake inhibitor (SSRI) citalopram and rivastigmine, an acetylcholinesterase inhibitor (AChEI). We then provide a brief literature review on the treatment of vascular behavioral impairment. The patient was initially evaluated in a psychiatric outpatient clinic, accompanied He was admitted at a clinical hospital due his emotional state and to co-morbidities, when he received psychiatric, neurologic and general medical evaluations. Results: Following a diagnosis of a mood disorder with associated cognitive symptoms, treatment was started, combining psychotherapy and citalopram, leading to a partial response. A series of adjuctive antidepressants were added, each quickly discontinued after the patient developed various adverse effects. Given both cognitive and mood residual symptoms, rivastigmine was added to citalopram, and the combination resulted marked improvement in depression, with reduction from 23 to 7 points on the Hamilton Depressive Scale (HAM-D), and improved cognition, reflected in an increase from 25 to 28 points in the Mini-Mental State Examination (MMSE) score. The patient was followed annually for six years with both clinical and cognitive evaluations, and at the end of this time he died after a stroke and brief period of significant clinical and cognitive decline. At the time of his last psychiatric evaluation, a few months prior to his death, the patient met criteria for vascular dementia. Conclusion: In this single case report, we highlight important features of the treatment of mood disorder and cognitive due to cerebrovascular disease. A brief review of literature found studies demonstrating improvement of vascular behavioral cognitive impairment, after treatment with the combination of association of SSRIs and AChEIs. These studies point to the need for randomized controlled trials of combination treatment for this condition.