A Surprising Number of Medications Dull Mental Edge

A Surprising Number of Medications Dull Mental Edge

Wednesday, 21 May 2008, 03:00 CDT
By Joe and Teresa Graedon peoplespharmacy@gmail.com

Patients should not have to choose between bladder control and brain function, but some medications prescribed for overactive bladder can have a negative impact on memory and concentration.

In a recent study, researchers followed more than 800 older Catholic nuns, priests and brothers for eight years, testing mental function annually. Those who were taking medications called anticholinergics (drugs for overactive bladder, Parkinson's disease, stomach cramps, motion sickness and ulcers) had greater declines in test scores.

This finding should not come as a great surprise to doctors. The neurochemical acetylcholine is essential for nervous-system function. Anticholinergic drugs interfere with its ability to bind to nerve cells.

Loss of bladder control is extremely distressing to older people and their families. That's why doctors prescribe drugs like Detrol (tolterodine) or Ditropan (oxybutynin). They don't always warn people, however, about side effects such as disorientation, drowsiness, insomnia, agitation or hallucinations.

One reader described her mother's situation: "My mother was recently prescribed Detrol. She has become increasingly disoriented and has a lot of trouble sleeping. It's really heartbreaking to see her go this way in bits and pieces.

"She has no appetite or energy, but they keep piling on more and more medication. Her kidney doctor said that the Detrol had no side effects, but a regular doctor said it could cause disorientation. Her quality of life (and ours) is suffering. She is becoming less and less able to take care of herself."

A study at Wake Forest University School of Medicine found that older people taking such anticholinergic medicines slow down physically as well as mentally. They walk slower and are less able to care for themselves.

Drugs for overactive bladder are not the only problem. A surprising number of medications can interfere with the action of acetylcholine, leading to negative effects for both physical and mental well-being.

In addition to medications for bladder control, many old- fashioned antidepressants such as amitriptyline (Elavil) also have anticholinergic activity. These drugs are not prescribed as much for depression these days, but they are increasingly used to treat debilitating nerve pain.

More surprisingly, the antihistamine diphenhydramine (Benadryl) also has significant anticholinergic action. Because this drug causes drowsiness, it is frequently found in over-the-counter sleep medications such as Nytol, Simply Sleep, Sominex and Unisom SleepGels. It is also a key ingredient in popular nighttime pain relievers such as Advil PM, Alka-Seltzer PM, Excedrin PM and Tylenol PM.

Many other medications also have some anticholinergic activity. The list is too long to reproduce here, but some of the medicines include scopolamine (Transderm Scop) for motion sickness, prednisone for inflammation, nifedipine (Adalat, Procardia) for blood pressure control and phenobarbital for sedation.

No one should stop such medications without consulting a physician, but older people experiencing symptoms of disorientation or memory loss should have their medications evaluated. A family member may need to request this if the patient is unable to do so.

Q: I was put on Cymbalta to stop hot flashes from menopause. When I switched doctors, my new physician was angry that I had been put on an antidepressant for hot flashes and put me on hormones instead.

I am now trying to stop taking Cymbalta. The dosage was reduced for several months. Then I took a pill every other day for months. I have not taken any for more than two weeks, and my life is a living hell.

I cannot turn around without falling over from dizziness. I cannot go up or down stairs without falling. Running or exercising is out of the question. No one told me that this would happen. How much longer will these dizzy spells continue? Is there anything I can do to stop them?

A: Cymbalta is not the only antidepressant that can cause trouble upon discontinuation. Doctors don't always warn patients about the possibility of withdrawal symptoms (dizziness, difficulty concentrating, sweating, anxiety, insomnia or electric shocklike sensations) when they prescribe such medicines.

Another reader related this: "I am experiencing the 'brain shivers' of Effexor withdrawal. I reduced the dosage from 75 mg to 37.5 mg and had been on that dose for a month. I have been off for about a week, and I have constant brain shivers. Is there anything that can help lessen these odd side effects?"

We don't know of any good way to diminish the uncomfortable side effects resulting from withdrawal except to take it even more slowly.

Q: My husband is 61 and vigorous. He insists that his difficulty with erections is due to us having sex less often than three to five times a week. We manage roughly once a week, but that is challenging since he is not even semi-hard. Is it possible that lack of use causes a man to lose his erection?

I'm 50 and believe I'm starting menopause. My sex drive isn't what it used to be. I hope you can answer this question and help us settle the conflict.

A: Your husband is mistaken. According to Irwin Goldstein, M.D., editor of the Journal of Sexual Medicine, having sex every day -- even if that were feasible -- would not restore your husband's ability to have an erection.

Erectile dysfunction can be a symptom of underlying medical problems and requires a complete checkup. Certain medications also might be responsible. ED can be treated successfully with drugs or devices. Your libido also can be given a boost if your hormones are out of balance.

We are sending you our Guides to Drugs That Affect Sexuality, Treating Sexual Dysfunction and Female Sexuality so both of you can consider options for improving your sex life without blame. Anyone who would like copies, please send $3 in check or money order with a long (No. 10), stamped (59 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. YPZ-962, P.O. Box 52027, Durham, NC 27717-2027. They also can be downloaded from our Web site: www.peoplespharmacy.com.

Q: Does eating licorice candy interfere with any prescription drugs?

A: Licorice can raise blood pressure and increase potassium loss, so it might interfere with the effectiveness of many blood pressure medications. People taking Lanoxin (digoxin) or Coumadin (warfarin) should probably avoid licorice. Prednisone or diuretics that deplete potassium are also problematic. When in doubt about interactions, check with your pharmacist.

(c) 2008 Roanoke Times & World News. Provided by ProQuest Information and Learning. All rights Reserved.
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