What drugs are anticholinergic antidepressants

When drugs cloud the mind

Harry Sander, the pensioner* Since the death of his wife, he has been behaving strangely: he no longer knows how to make coffee and can no longer find the way to the bus stop by himself. His son suspects that it is beginning dementia and takes the father to the memory clinic in Hanover. "The 70-year-old had significant memory gaps", remembers the geriatrician Dr. Olaf Krause from the Medical University of Hanover."But if older people are confused, it can often be the result of certain drugs, for example those with anticholinergic agents."

Drugs cause memory lapses

The geriatrician asked the pensioner whether and which medication he was taking regularly. And Sander actually pulled an antidepressant with anticholinergic effects out of his toiletry bag. His family doctor had prescribed this for him after his wife's death. "We then stopped the drug and after a week the patient was clear in his head and had normal memory function"says Krause."But the connection is not always that clear and the patient does not always recover so well when the drug is discontinued."

Anticholinergics are found in many drugs

Anticholinergic effects have been described for more than 600 drugs. They suppress the action of the messenger substance acetylcholine and - to put it simply - act on the interaction of muscles and nerves. Anticholinergic effects can be desired therapeutically, but they can also occur as undesirable side effects. They are used therapeutically in Parkinson's drugs, drugs against nausea or incontinence. As an undesirable side effect, anticholinergic effects occur e.g. with tricyclic antidepressants or anti-allergy tablets.

Do nerve cells die?

In any case, caution is advised when handling anticholinergics, as a study by Canadian researcher Shannon Risacher has now shown. Her research group has shown that older people who took drugs with strong anticholinergic effects did worse in cognition tests than a comparison group and also had lower brain activity and brain volume. A causal connection between the active ingredients and nerve cell damage has not yet been proven.

Elderly people in particular are at risk

It has long been known that older people in particular are sensitive to anticholinergic agents. Nevertheless, the drugs are widely used: almost 40 percent of those over 75 who live at home take anticholinergics. Aging physicians such as the dementia specialist Prof. Klaus Hager from the Diakovere Henriettenstift Hannover advocate more careful handling when prescribing such substances. "For us this is our daily bread - if we look through people's list of medicines, we always find unsuitable medicines among them."- The risk groups for anticholinergic side effects include elderly people who take psychotropic drugs, patients with Parkinson's disease and those with dementia.

Also be careful with over-the-counter drugs

"It becomes particularly problematic when patients also get over-the-counter medication from the pharmacy"warns the specialist pharmacist for geriatric pharmacy Dr. Beate Wickop from the University Medical Center Hamburg-Eppendorf. Because even over-the-counter items can contain anticholinergic agents."The effects add up, which is particularly risky."She advises you to bring a list of all medications you have taken with you every time you visit the doctor or pharmacy.

* Name changed by the editor