Increasing Concern About These Medications
There is increasing concern that a small set of medications often prescribed to help people sleep may increase risk of dementia including Alzheimer’s disease. These medication were not created specifically for this purpose but have been found to have the happy side effect of helping people sleep. The concerning thing about these medications is that they block a chemical in the brain called acetylcholine (ACTH). When this brain chemical is blocked, risk for dementia increases significantly.
There are many medications that block ACTH but there are six that are frequently used for sleep. They are:
• Elavil (Amitriptyline)
• Benadryl (Diphenhydramine-This is in many OTC sleep aids such as Zzzquil, Tylenol PM, Advil PM, and others)
• Doxepin (Sinequan, Silenor)
• Hydroxyzine (Vistaril, Atarax)
• Seroquel (Quetiapine)
• Trimipramine (Surmontil)
Some medications used for other health problems (depression, allergies, seizures, abnormal heart rhythms, Parkinson’s disease, nausea, vertigo, bladder problems, and breathing problems) also block this chemical and increase what is called the, “anticholinergic burden.”
The anticholinergic burden or ACB is a fancy name for the cumulative effect of all of the ACTH blocking drugs you are taking. This means that the more of these drugs you are taking, the higher your ACB score, and the higher the risk for dementia.
What Should I Do If I’m Taking One Of These Medications?
I want to be clear that taking one or more of these anticholinergic medications does not mean you are going to develop dementia. It just means that there is research that tells us that people who take these medications are at greater risk for dementia than those who don’t. With that said, the less anticholinergic medication you take the lower your risk so let’s talk about steps you can take to lower your use of these medications.
Step 1: Sleep Medications
If you are taking one of the six sleep medications I listed above, the first thing I recommend is to try cognitive-behavioral therapy for insomnia (CBT-I). Much more than “sleep hygiene” or “healthy sleep habits,” CBT-I is a brief, well-researched, non-medication treatment recommended by the American College of Physicians. CBT-I can help you restore healthy sleep while reducing or eliminating the need for sleep medications. If you would like help deciding if CBT-I sleep training is right for you, call or email us to set up a free 15-minute phone consultation.
Step 2: Medications for Other Health Problems
If you are taking other medications I recommend talking with your prescriber about the issue of anticholinergic burden and risk of dementia. They can help you identify medications with anticholinergic effects, provide and opinion of your personal risk, and propose a treatment plan that is best for you. Estimating your personal risk for any health problem is complex. Here are a few things to keep in mind when having this conversation:
- There may be alternative medications with similar benefits without the risk of increased anticholinergic burden.
- The benefits of the medication may outweigh the risks and your prescriber may feel that continuing the medication is the best choice for you.
- The research I’ve based this post on is listed at the bottom of the page. I encourage you to take a look at it for yourself and even take it with you to the appointment with your prescriber.
- Your prescriber may disagree with what I’ve written in this post and that’s ok. They know you and your personal health factors and are there to work with you to help make the best decisions for your health.
- Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case Control Study. JAMA Intern Med. 2019: doi:10.1001/jamainternmed.2019.0677
- Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016: doi:10.7326/M15-2175