Anticholinergic Psychiatric Drugs Linked to a 50% Increase in Dementia

People who take anticholinergic drugs, such as antidepressants and antipsychotics, are at a 50% higher risk of dementia.

Peter Simons
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People who take anticholinergic drugs, including antidepressants and antipsychotics, are at a 50% higher risk of dementia than the average population, according to a new study. The researchers suggested that the adverse effects of these drugs may result in about 20,000 cases of dementia per year in the UK alone.

The research was led by Carol Coupland at the University of Nottingham, UK, and published in the journal JAMA Internal Medicine.

According to the researchers, “The present study adds further evidence of potential risks associated with strong anticholinergic drugs.”

Coupland and the other researchers matched 58,769 individuals with dementia diagnoses with 225,574 people without dementia diagnoses, all between the ages of 55 and 100. They then compared the use of anticholinergic drugs, including antidepressants and antipsychotics, between these two groups.

“There were significant increases in risk associated with the use of antidepressants, antiparkinson drugs, antipsychotics, bladder antimuscarinics, and antiepileptic drugs,” they write.

Antidepressants were the most commonly prescribed drug in the study, and people who used them were at a 29% increased risk of dementia compared to non-users. However, antipsychotics were responsible for the greatest risk of dementia, a 70% increased risk.

The researchers estimated that 10% of all new dementia cases are due to the adverse effects of these medications. Given the approximately 200,000 new cases of dementia each year in the UK, 20,000 of them would be due to adverse effects, according to Coupland.

An “invited commentary” in the medical journal downplayed the results, suggesting that because the study was longitudinal, it could not be used to say that the drugs “caused” dementia. Instead, some other factor may have been associated with both dementia and drug use. However, the researchers conducted numerous sensitivity analyses and checked for potential confounding factors; their results continued to be significant.

In fact, research has consistently shown that use of anticholinergic drugs is associated with later development of cognitive problems and diagnoses of dementia, and the people who use them longer and more often are at greater risk.

 

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Coupland, C. A. C., Hill, T., Dening, T., Morriss, R., Moore, M., & Hippisley-Cox, J. (2019). Anticholinergic drug exposure and the risk of dementia: A nested case-control study. JAMA Intern Med. Published online June 24, 2019. doi: 10.1001/jamainternmed.2019.0677 (Link)

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17 COMMENTS

  2. “In fact, research has consistently shown that use of anticholinergic drugs is associated with later development of cognitive problems and diagnoses of dementia, and the people who use them longer and more often are at greater risk.”

    And in the short run the anticholinergic drugs can cause “hallucinations” and “psychosis,” via anticholinergic toxidrome. A medically known way to poison people, of which most of our psychiatrists claim ignorance, since anticholinergic toxidrome is, conveniently for the psychiatrists, missing from their DSM.

  3. Anticholinergic drugs may indeed increase risk for dementia. However, a study such as this can only suggest not prove causality no matter how many sensitivity analyses are done and how many confounding factors are checked. The increased risks presented in the article refer to relative risk. This kind of statistic is often used by researchers to overstate their case for the efficacy of a drug or in this case possibly overstate the dangers of anticholinergics. The article should have provided the absolute risk of taking the drugs. I am very suspicious of many drugs (including very common ones) and firmly believe they are over prescribed especially for psychiatric conditions. But it doesn’t help the case against these drugs to present incomplete information.

  4. Thank you, Peter, for sharing this study. The results are dramatic in showing that patients taking anticholinergic drugs are at much higher risk for getting dementia, especially if taking antipsychotics. I hope this leads to more studies to confirm these results as well as MDs being more cautious to prescribe these drugs. Dementia is a devastating illness to patients, their family members and caregivers.

  5. A 70% increase in risk with antipsychotics. It’s likely the reason for that, is that people are prescribed them for much longer. It would be more useful if they included that type of information as well. It might have an effect on prescribing practice. Or, they just switch you to an antipsychotic without an anticholinergic component.

  9. I spent years refusing to get a diagnosis of bipolar. That “politically correct” label leaves someone diagnosed with it the impression that the wiring in their brain needs a complete overhaul. You go visit a psychiatrist and they go through their criteria check sheet to see if your behavior, moods and thinking don’t meet what society and big money deem as normal. Normal may still be a cycle on a washing machine but they are machines built to all perform a specific job. It seems society has developed this need to control and behavior seen as different threatens their control of what they don’t understand and of coarse the pharmaceutical companies are so obscenely getting even richer off anything that gets labelled an illness and add mental to the illness the opportunities become endless. I’m sure they are heavily involved in that criteria check to because more than likely if you go in to see if you have some supposed mental illness you will be told you have something very wrong with your mind and like clockwork out comes the prescription pad and guaranteed you will leave the Dr’s office with at least one prescription and a certainty that you now know theirs something wrong with your mind. I soon realized after receiving a diagnosis of one why I had refused to get one for almost 15 years. Now over 20 years later the damage done by the psychiatric field still still effects me. The DSM is nothing more than some list of rules to qualify making that so needed diagnosis so you qualify to get insurance to cover all the many drugs you will be told are so necessary to take the rest of your life. This article is enough to scare the crap out of anyone that has taken these type of drugs.I’m 64 and that’s an age that thoughts of dementia are getting a little to close. About 3 years after being diagnosed I was put on seroquel. It really was the first time I really started taking instead of flushing the drugs. I’d been on disability for over 2 years by then and figured they must be right that I was really sick. Six weeks after starting seroquel I ended up in the hospital from a first suicide attempt. When I got there I was told I was severely diabetic. I was shocked. I’d had lab tests 2 weeks before starting the drug and my sugar was normal. I had no family history of it and at that time I was still thin. It made no sense. I had looked up the drug when I got it and no mention of it causing diabetes. The next year and a half were a nightmare. They couldn’t get my sugar down, my perfectly good teeth started rotting, my gut was torn up daily, gained over 20 pounds and I I felt like I was in some fog when I happened on an article that said it might be causing diabetes. I went off it cold turkey that day. I just knew that had to be the problem. Withdrawal was awful. I still had diabetes but the medication for that finally started working and my sugar went down. I had to change psychiatrists because the one that prescribed it told me I was acting delusional and refused to take me off the drug. By that time I was getting used to being told when I occasionally stated a differing opinion that I was delusional. I found out fast to never state my real feeling about bipolar. I had always viewed it as a gift and not some illness which was why I refused to get dx’d for so long. I wanted no part of medication that was going to take away my gift. I was 29 when I realized it wasn’t depression after my dad told me that it was very hereditary in his family. I had never known that both my grandmother and her brother had spent years institutionalized for it. I had had some depressions and taken antidepressants a few times but within a couple weeks was feeling great and stopped taking them. I always related these great feelings as having one of those great springs again as I I was very seasonal for years. I decided to look up manic depression and realized I didn’t have depression and that must be those great springs. The psychiatrist that dx’d me told me that you had to have the gene to get it but it usually came out from environment. No one ever questioned the environment I grew up in. Once you get that DSM dx everything that happens because of that dx. Why look further now that they have you in the system and hooked on the damn meds and you’re nothing but a shadow of your former sell. You just accept what they tell you and for many years if you got out of line they threw you in the hospital and shot you full of haldol and you just hoped they added the counteracting drug because if they didn’t you’d soon be feeling like every muscle in your body was gone. It only happened one time but the didn’t tell me they have to add I believe it’s ativan or this happens. No Dr ever told me about it. It was other patients that had been through it that told me what was happening. Involuntary hospitalization is often more traumatizing than helpful. The first time I was baker acted in Florida my mother requested it. I overheard them say it and tried to run because I was scared. I was only hypomanic and not hospital material at the time. Trying to run was just proof that I needed it. No one even questioned why a mother would do what she did. She just watched as 4 big guys grabbed me and threw me down on the concrete floor of the ER and I saw this shot being pushed in my stomach. I didn’t realize they could give you something against your will at that time. I woke up hours later in 4 point restraints. I was left in them 14 hours straight without time out. They really do hurt. I was never fed and had no way to reach the water on the nightstand. I had no idea that I had lost my humanity and was now just a diagnosis with no dignity left. After arriving at the mental hospital the only compassion I received was from other patients. The staff just barked orders. We were all just treated with contempt as to the staff we were nothing more than a bunch of deranged, dx’d mental cases. If you try to demand respect it means your fighting the system which is just added proof to how sick you are and they look at you with fear because now with the bipolar dx it means you might kill. The media just clamoring for sensationalism adds fuel to the fire. I was still flushing meds then and my spirit was still alive and well. I still had the audacity to call them out for their behavior but all the credibility I had just a year earlier was gone. At the time of dx I was still running my own architectural business. Now I was just waiting on my first disability check. A very toxic former friend typical of the type I seemed to attract took it on to let my customers know my dx. One of my bigger accounts just disappeared. It didn’t occur to me why they just disappeared until she told me she had told them as in her words she felt they deserved to know that I was “mental” now. I had no idea then of the abuse I had grown up with. I thought the mania I woke up with at 15 was what saved me from the suicide I was planning. I still believe it was the mania that saved me. It did come on because of my environment. It didn’t occur to me that I was being abused by both my mother and older half sister since early childhood. Much of the abuse I now know was done through gaslighting and severe religious abuse. It was drilled in to me that I was a very bad person. After the bipolar diagnosis and numbed out on psychiatric drugs my mother and sister were able to push their way back in my life and turned my life back in to ongoing trauma. Antipsychotics dumb you out. They rob you of your personality. I finally ditched most of the meds and was able to take back control of my life but financially I’m ruined. I’ve spent 6 years trying to heal from the CPTSD but seems I’m treatment resistant. I feel I have one option left but at this time it’s illegal. The micro-dosing a psychedelic. They say it heals PTSD. The pharmaceutical companies will never allow it as all they want to produce are drugs to supposedly control symptoms as long as you take them for life. They don’t want a cure because the money is in ongoing use. As usual I wrote to long a post. Sorry. I’m a writer, presently writing a book actually and sometimes I I tend to write too much in posts. My verbal skills are not real good so I write.

    • LWRfree, Thank you for sharing your story. I’m so sorry you had to endure such a long horrible nightmare with psychiatry. I hope you are doing better these days. Do you still have to take diabetes medication or was your system able to recover from the Seroquel? Best wishes to you in the future and on writing your book!

  11. Actually about 3 years ago my endocrinologist said it is flat out gone. I had been off meds for it for over a year before he deemed me cured of it. People argue that you can’t be cured of it but the only reason it went away was because I got it from the drug. I really didn’t think it would ever disappear but sooo grateful.