Some antidepressants linked to dementia risk

by Jared Lewis April 27, 2018, 1:14
Some antidepressants linked to dementia risk

Amitriptyline was in the news in February, named as the most effective of the antidepressants in a study.

Anticholinergic drugs help treat depression, as well as other ailments such as bladder conditions or Parkinson's.

"They need to consider the risk of long-term cognitive effects, as well as short-term effects, associated with specific drugs when weighing up risks and benefits". There are 1.5 to 2 million people in England alone on this type of drug.

However, "it is well known that anticholinergics affect cognition, and guidelines suggest they are to be avoided among frail, older people", they state. This means that some, but not all, anticholinergic drugs were implicated.

"Many medicines have this activity, and I think the key things from our finding is that it probably shifts the balance looking at risks versus benefits", said Ian Maidment, senior lecturer in clinical pharmacy at Aston University and another author on the study.

The research, funded by Alzheimer's Society and published today in the BMJ, also shows a dementia risk associated with medications prescribed for bladder conditions (for example Tolterodine, Oxybutynin and Solifenacin), and Parkinson's (for example Procyclidine).

To examine these associations, researchers used multiple conditional logistic regression to evaluate patients with a new diagnosis of dementia and compared their anticholinergic drug use 4-20 years before diagnosis; they were then matched to a control group without dementia.

Anticholinergic drugs are created to block the neurotransmitter acetylcholine in the central or peripheral nervous system, and have diverse actions, dependent on the site, the researchers explain. Researchers compared the records to those of over 283,000 people without dementia to determine risk, according to the BBC.

Long-term use of anticholinergic medications for Parkinson's disease, bladder conditions, and depression was associated with an increased risk for dementia, a case-control study found.

Patients who took anticholinergics for more than a year had around a 30 per cent increased risk of dementia, researchers said. However, after a new study written by researchers at the University of East Anglia, we now face a new question: what should we do? The early symptoms of dementia include depression and urinary incontinence, so it is possible the drugs were sometimes being prescribed for people who already had the early stages.

Anticholinergic antidepressants have been found to be linked with dementia, even when taken up to 20 years before a diagnosis.

Professor Chris Fox from East Anglia, one of the authors, thinks doctors should de-prescribe.

The researchers do stress that patients prescribed anticholinergic drugs shouldn't just stop taking their medicines.

A spokesperson for the Medicines and Healthcare Products Regulatory Authority said it would look to see if any action should be taken."Patient safety is our highest priority and we continuously monitor the safety of all medicines on the United Kingdom market".

However several other anticholinergic medications, including anti-histamines and those used for abdominal cramps, were not found to be linked to dementia - despite previous research suggesting that any anticholinergic might represent a risk. They conclude that clinicians should be vigilant with respect to anticholinergic drugs and should consider long-term cognitive effects.


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