Antidepressants and Dementia
Kaiser Health News recently published an article
about common medications that can impact cognitive functioning.
"A wide variety of medications used to treat allergies, insomnia, leaky bladders, diarrhea, dizziness, motion sickness, asthma, Parkinson’s disease, chronic obstructive pulmonary disease and psychiatric disorders can interfere with cognition in older patients."
The medications in question are anticholinergic drugs. We have known for a while
that anticholinergic drugs can impact our brains.
Anticholinergic drugs work by blocking the effect of acetylcholine, an important neurotransmitter. Acetylcholine plays an important role in memory and cognition in the brain. Severe depletion of acetylcholine is associated with dementia.
The 2019 Beers Criteria, a listing of potentially inappropriate medications to use in older adults, states that anticholinergic drugs should be avoided in the elderly whenever possible. They should be avoided (or considered with caution) because they often present an unfavorable balance of benefits and harms for older people.
Included on the list of anticholinergic drugs are antidepressants. Does this mean that antidepressants should be avoided?
You have to read the information very carefully. Not all antidepressants have anticholinergic effects. Tricyclic antidepressants,
a specific group of antidepressants, works by increasing norepinephrine and serotonin and blocking the actions of acetylcholine and histamine.
The research suggests
that tricyclic antidepressants may impact cognitive functioning.
It’s worth remembering that avoiding anticholinergic drugs won’t necessarily prevent dementia. Age is still the one of the biggest risk factors for developing dementia. About 32% of people age 85 and older have dementia. Despite attempts to protect the brain, everyone is at some risk for developing dementia if they live long enough.
So, even if the antidepressant you are taking does carry risks of cognitive impairment, the drug might still be the right option for you. Some risks are worth taking because the short-term benefits outweigh the potential consequences. These are topics for discussion with your prescriber-you do not have to nor should you evaluate this alone
Psychotropic medications should be overseen by a psychiatrist and reviewed regularly (and more than just annually for older adults). For our clients, we recommend working with a geriatric psychiatrist
If you have questions about your antidepressant and its risks, please talk to your doctor. The data research on these medications (and all medications) are being evaluated all the time; but these medications are worth asking your prescriber about if you are noticing or concerned about changes to your cognition.
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