We’ve actually known for a while that a certain type of drug might have unique risks in terms of promoting mental decline in the elderly. There was a meta-analysis done in 2014 that offered the cheery reassurance that there was no statistically significant evidence that these drugs will make you die any younger, but a lot of evidence that they’ll speed your physical and mental decline. For whatever reason, though, not a lot of people seemed to know about these studies until last month, when a new one came out that said yes, for sure, we’re really quite certain that taking Benadryl, Xanax, Unisom, or a long, long list of other drugs is thoroughly linked to dementia risk.
Anticholergenic drugs block one of our neurotransmitters, acetylcholine. They have a lot of uses: the coverage has focused on sleeping pills, but the list also includes antihistamines, tricyclic antidepressants, muscle relaxants, anti-nausea medications, and drugs used to treat overactive bladder, Parkinson’s, COPD/emphysema, irritable bowel syndrome, and asthma. Wellbutrin is on the list. Dextromethorphan, the cough suppressant that’s in every bottle of over-the-counter cough syrup with DM in the name, is also the list. While unsuccessfully hunting for a complete list of all drugs with anticholinergic effects, I found an article for pharmacists that classified drugs with anticholinergic activity into medium/high activity and low activity which might be useful if you’re wondering how worried to be.
With a few exceptions, most of the drugs that fit this description are older medications and therefore relatively cheap. One of the characteristics of anticholinergic drugs is that they tend to make you sleepy, which is why so many of them are sleeping pills. If you want relief from nausea or hay fever, you would probably prefer that the drug not knock you on your ass, and newer drugs for this stuff are generally less likely to have anticholinergic effects. Benadryl, an antihistamine that has been available since 1946, is an anticholinergic. Zyrtec, an antihistamine which was approved for over-the-counter sales in 2007, is not. Phenergan, available since the 1950s, is an anticholergenic. Zofran, developed in the 1980s and still shockingly expensive, is not. Unfortunately, this means that there may be pressure on patients – overt, or subtle – to give the old-line medications a try before they break out the latest and greatest.
So. If you’re taking one of these drugs – and make no mistake, if you’re taking that drug daily, unless you just started last week, you’re already in the high-risk group – how worried should you be?
The new study was done specifically on older people. Most of the studies on the risks of anticholinergic drugs have been on people 65 and over. If you’re 40, they don’t really know what the risk is. Maybe these drugs become riskier as you get older. Or, maybe the longer you take one of these drugs, the higher risk you have for dementia years down the road. They don’t know.
Another thing they don’t know: whether it’s worth going off the drug, if you’ve been taking it for years, or if the damage has already been done.
We do have a sense of the mechanism here. Anticholinergic drugs block acetylcholine. Among other things, acetylcholine in the brain appears to prevent some of the damage that Alzheimer’s causes, to the point that boosting it can be used to improve cognitive function. So, again, this isn’t some out-there who’d-ever-have-imagined sort of study. We know that anticholinergic drugs do stuff to your brain (that’s how they work), we know that the neurotransmitter these drugs suppress is something that protects you against dementia, and we know that the people who use these drugs are more likely to decline physically and mentally as they age.
So what do you even do about it?
Some of these drugs are semi-optional, or have high-quality alternatives. The drugs for “overactive bladder” have been heavily marketed to consumers but in many cases having to pee a lot is a convenience issue, not a medical condition. If you’re taking a drug like this, it’s probably worth asking yourself whether spending less time in the bathroom is worth raising your risk of Alzheimer’s by 50% or more.
On the other hand, maybe you’re taking a tricyclic antidepressant because nothing else helped you. Or you’re taking Flexaril for muscle spasms because you don’t want to spend your life in pain. Or you’re taking drugs that make your colon work properly, or let you breathe.
If you need one of these drugs, the important thing to bear in mind is that all drugs have risks. If the alternative to taking an anticholergenic drug is living in pain, that is also a risk. If the treatment for your chronic condition raises your risk for dementia, then that’s one more crappy thing about your chronic condition – it doesn’t mean that you should stop treating your chronic condition.
It’s worth using this study to badger your insurer into covering the latest and greatest, if the latest and greatest lacks anticholinergic effects. But fundamentally, your quality of life right now counts for a lot.
And if your concern-troll friend says, “but those DRUGS you’re taking! They cause ALZHEIMER’S!” maybe warn them that there is a strong and well-established correlation between being a concern troll friend and not getting invited to your parties anymore.
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