The internal functions of our bodies are controlled by the so called ‘autonomic nervous system’, which is made up of the sympathetic system, the ‘fight or flight’ branch, and the parasympathetic system, the ‘rest and digest’ branch. This article will focus on the parasympathetic system, and drugs that block its actions. These drugs are called anticholinergics; they are found in a wide variety of over the counter and prescription medications, including some antihistamines, certain antidepressants, and drugs used for an overactive bladder.
Several recent studies have shown an increased risk for pneumonia and also for cognitive decline in older people (ages 65-94) using these drugs. A study from the University of Washington, published in the Journal of the American Geriatrics Society, showed a significantly higher risk of developing pneumonia among 3000 elderly members of a group health plan if they had taken prescription or over the counter anti-cholinergic medications in the past 90 days. Another study from this same group showed a significantly increased risk of developing dementia, including Alzheimer’s disease, in elderly patients taking anticholinergic meds at higher doses for a longer time. These drugs included Benadryl, which is used in several over the counter sleep aids, such as Nytol, Excedrin PM, Midol PM, Tylenol PM, and Advil PM. The study was published in JAMA Internal Medicine in 2015.
The authors of these studies concluded that patients should tell their doctors about all over the counter remedies they are using, and doctors should similarly inquire about all meds being taken. The most commonly used medications in the dementia study were tricyclic antidepressants like Sinequan, antihistamines like Chlor-Trimeton, and Ditropan for control of an overactive bladder. The risk of dementia increased after 3 years of use. The authors concluded that substitute drugs that would be safer include SSRI antidepressants such as Celexa or Prozac, Claritin for allergies, and behavioral changes, rather than drugs, for an overactive bladder. This would mean cutting back on caffeine and alcohol, and setting an alarm for every hour or two during the day as a reminder to urinate.
There are natural ways to get in close touch with your parasympathetic nervous system, which all my readers will know: breathing exercises designed for self-calming, the relaxation response, meditation, massage, yoga, and chi-gong. Wear blue-blocking glasses for an hour before bedtime to maximize your brain's production of melatonin to help you relax into sleep. (See Restorative Sleep, 4/9/12, on this blog)
Be sure to talk to your doctor or nurse practitioner about all meds and supplements you are taking at your next visit. If you are older, or have elderly parents, be especially mindful.
Sadja Greenwood, MD, MPH Leave me a message, and I'll reply.