A few years ago, while I was at a family celebration, several people mentioned memory concerns to me.
Some were older adults concerned about the memory of their spouses. Some were adult children concerned about the memory of their parents. And a few were older adults who have noticed some slowing down of their own memory.
“But you know, nothing much that can be done at my age,” remarked one man in his eighties.
Wrong. In fact, there is a lot that can and should be done, if you notice memory or thinking changes in yourself or in another older adult. And you should do it because it ends up making a difference for brain health and quality of life.
First among them: identify medications that make brain function worse.
This is not just my personal opinion. Identifying and reducing such medications is a mainstay of geriatrics practice.
And the expert authors of the National Academy of Medicine report on Cognitive Aging agree: in their Action Guide for Individuals and Families, they list “Manage your medications” among their “Top 3 actions you can take to help protect your cognitive health as you age.”
Unfortunately, many older adults are unaware of this recommendation. And I can’t tell you how often I find that seniors are taking over-the-counter or prescription medications that dampen their brain function. Sometimes it’s truly necessary but often it’s not.
What especially troubles me is that most of these older adults — and their families — have no idea that many have been linked to developing dementia, or to worsening of dementia symptoms. So it’s worth spotting them whether you are concerned about mild cognitive impairment or caring for someone with full-blown Alzheimers.
Every older adult and family should know how to optimize brain function. Avoiding problem medications — or at least using them judiciously and in the lowest doses necessary — is key to this.
And don’t give anyone a pass when they say “Oh, I’ve always taken this drug.” Younger and healthier brains experience less dysfunction from these drugs. That’s because a younger brain has more processing power and is more resilient. So drugs that aren’t such problems earlier in life often have more impact later in life. Just because you took a drug in your youth or middle years doesn’t mean it’s harmless to continue once you are older.
You should also know that most of these drugs affect balance, and may increase fall risk. So there’s a double benefit in identifying them, and minimizing them.
Below, I share the most commonly used drugs that you should look out for if you are worried about memory problems.
The Four Most Commonly Used Types of Medications That Dampen Brain Function
1. Benzodiazepines. This class of medication is often prescribed to help people sleep, or to help with anxiety. They do work well for this purpose, but they are habit-forming and have been associated with developing dementia.
- Commonly prescribed benzodiazepines include lorazepam, diazepam, temazepam, alprazolam (brand names Ativan, Valium, Restoril, and Xanax, respectively)
- For more on the risks of benzodiazepines, plus a handout clinically proven to help seniors reduce their use of these drugs, see “How You Can Help Someone Stop Ativan.”
- Note that it can be dangerous to stop benzodiazepines suddenly. These drugs should always be tapered, under medical supervision.
- Alternatives to consider:
- For insomnia, there is no easy and fast alternative. Just about all sedatives — many are listed in this post — dampen brain function. Many people can learn to sleep without drugs, but it usually takes a comprehensive effort over weeks or even months. This may involve cognitive-behavioral therapy, as well as increased exercise and other lifestyle changes. You can learn more about comprehensive insomnia treatment by getting the Insomnia Workbook (often available at the library!) or something similar.
- For anxiety, there is also no easy replacement. However, there are some drug options that affect brain function less, such as SSRIs (e.g. sertraline and citalopram, brand names Zoloft and Celexa). Cognitive behavioral therapy and mindfulness therapy also helps, if sustained.
- Even if it’s not possible to entirely stop a benzodiazepine, tapering to a lower dose will likely help brain function in the short-term.
- Other risks in seniors:
- Benzodiazepines increase fall risk.
- These drugs sometimes are abused, especially in people with a history of substance abuse.
- Other things to keep in mind:
- If a person does develop dementia, it becomes much harder to stop these drugs. That’s because everyone has to endure some increased anxiety, agitation, and/or insomnia while the senior adjusts to tapering these drugs, and the more cognitively impaired the senior is, the harder it is on everyone. So it’s much better to find non-benzo ways to deal with anxiety and insomnia sooner, rather than later. (Don’t kick that can down the road!)
2. Non-benzodiazepine prescription sedatives. By far the most commonly used are the “z-drugs” which include zolpidem, zaleplon, and eszopiclone (brand names Ambien, Sonata, and Lunesta, respectively). These have been shown in clinical studies to impair thinking — and balance! — in the short-term.
- Some studies have linked these drugs to dementia. However we also know that developing dementia is associated with sleep problems, so the cause-effect relationship remains a little murky.
- For alternatives, see the section about insomnia above.
- Occasionally, geriatricians will try trazodone (25-50mg) as a sleep aid. It is thought to be less risky than the z-drugs or benzodiazepines. Of course, it seems to have less of a strong effect on insomnia as well.
- Other risks in seniors:
- These drugs worsen balance and increase fall risk.
3. Anticholinergics. This group covers most over-the-counter sleeping aids, as well as a variety of other prescription drugs. These medications have the chemical property of blocking the neurotransmitter acetylcholine. This means they have the opposite effect of an Alzheimer’s drug like donepezil (brand name Aricept), which is a cholinesterase inhibitor, meaning it inhibits the enzyme that breaks down acetylcholine. A 2015 study found that greater use of these drugs was linked to a higher chance of developing Alzheimer’s.
Drugs vary in how strong their anticholinergic activity is. Focus your energies on spotting the ones that have “high” anticholinergic activity. For a good list that classifies drugs as high or low anticholinergic activity, see here.
I reviewed the most commonly used of these drugs in my NextAvenue article, “7 Common Drugs That Are Toxic for Your Brain.” Briefly, drugs of this type to look out for include:
- Sedating antihistamines, such as diphenhydramine (brand name Benadryl).
- The “PM” versions of over-the-counter analgesics (e.g. Nyquil, Tylenol PM); the “PM” ingredient is usually a sedating antihistamine.
- Medications for overactive bladder, such as the bladder relaxants oxybutynin and tolterodine (brand names Ditropan and Detrol, respectively).
- Note that medications that relax the urethra, such as tamsulosin or terazosin (Flomax and Hytrin, respectively) are NOT anticholinergic. So they’re not risky in the same way, although they can cause orthostatic hypotension and other problems in older adults. Medications that shrink the prostate, such as finasteride (Proscar) aren’t anticholinergic either.
- Medications for vertigo, motion sickness, or nausea, such as meclizine, scopolamine, or promethazine (brand names Antivert, Scopace, and Phenergan).
- Medications for itching, such as hydroxyzine and diphenhydramine (brand names Vistaril and Benadryl).
- Muscle relaxants, such as cyclobenzaprine (brand name Flexeril).
- “Tricyclic” antidepressants, which are an older type of antidepressant which is now mainly prescribed for nerve pain, and includes amitryptiline and nortriptyline (brand names Elavil and Pamelor).
There is also one of the popular SSRI-type antidepressants that is known to be quite anticholinergic: paroxetine (brand name Paxil). For this reason, geriatricians almost never prescribe this particular anti-depressant.
For help spotting other anticholinergics, ask a pharmacist or the doctor, or review the list.
Alternatives to these drugs really depend on what they are being prescribed for. Often non-drug alternatives are available, but they may not be offered unless you ask. For example, an oral medication for itching can be replaced by a topical cream. Or the right kind of stretching can help with tight muscles.
Aside from affecting thinking, these drugs can potentially worsen balance. They also are known to cause dry mouth, dry eyes, and can worsen constipation. (Acetylcholine helps the gut keep things moving.)
4. Antipsychotics and mood-stabilizers. In older adults, these are usually prescribed to manage difficult behaviors related to Alzheimer’s and other dementias. (In a minority of seniors, they are prescribed for serious mental illness such as schizophrenia. Mood-stabilizing drugs are also used to treat seizures.) For dementia behaviors, these drugs are often inappropriately prescribed, as in this NYT story. All antipsychotics and mood-stabilizers are sedating and dampen brain function. In older people with dementia, they’ve also been linked to a higher chance of dying.
- Commonly prescribed antipsychotics are mainly “second-generation” and include risperidone, quetiapine, olanzapine, and aripiprazole (Risperdal, Seroquel, Zyprexa, and Abilify, respectively).
- The first-generation antipsychotic haloperidol (Haldol) is still sometimes used.
- Valproate (brand name Depakote) is a commonly used mood-stabilizer.
- Alternatives to consider:
- Alternatives to these drugs should always be explored. Generally, you need to start by properly assessing what’s causing the agitation, and trying to manage that. A number of behavioral approaches can also help with difficult behaviors. For more, see this nice NPR story from March 2015. I also have an article describing behavioral approaches here: 7 Steps to Managing Difficult Dementia Behaviors (Safely & Without Medications).
- For medication alternatives, there is some scientific evidence suggesting that the SSRI citalopram may help, that cholinesterase inhibitors such as donepezil may help, and that the dementia drug memantine may help. These are usually well-tolerated so it’s often reasonable to give them a try.
- If an antipsychotics or mood-stabilizer is used, it should be as a last resort and at the lowest effective dose. This means starting with a teeny dose. However, many non-geriatrician clinicians start at much higher doses than I would.
- Other risks in older adults:
- Antipsychotics have been associated with falls. There is also increased risk of death, as above.
- Caveat regarding discontinuing antipsychotics in people with dementia: Research has found that there is a fair risk of “relapse” (meaning agitation or psychotic symptoms getting worse) after antipsychotics are discontinued. A 2015 study of nursing home residents with dementia concluded that antipsychotic discontinuation is most likely to succeed if it’s combined with adding more social interventions and also exercise.
- You can learn more about medications to treat dementia behaviors in this article: “5 Types of Medication Used to Treat Difficult Dementia Behaviors“
A Fifth Type of Medication That Affects Brain Function
Opiate pain medications. Unlike the other drugs mentioned above, opiates (other than tramadol) are not on the Beer’s list of medications that older adults should avoid. That said, they do seem to dampen thinking abilities a bit, even in long-term users. (With time and regular use, people develop tolerance so they are less drowsy, but seems there can still be an effect on thinking.) As far as I know, opiates are not thought to accelerate long-term cognitive decline.
- Commonly prescribed opiates include hydrocodone, oxycodone, morphine, codeine, methadone, hydromorphone, and fentanyl. (Brand names depend on the formulation and on whether the drug is mixed with acetaminophen.)
- Tramadol (brand name Ultram) is a weaker opiate with weaker prescribing controls.
- Many geriatricians consider it more problematic than the classic Schedule II opiates listed above, as it interacts with a lot of medications and still affects brain function. It’s a “dirty drug,” as one of my friends likes to say.
- Alternatives depend on what type of pain is present. Generally, if people are taking opiates then they have pain that needs to be treated. However, a thoughtful holistic approach to pain often enables a person to get by with less medication, which can improve thinking abilities.
- For people who have moderate or severe dementia, it’s important to know that untreated pain can worsen their thinking. So sometimes a low dose of opiate medication does end up improving their thinking.
- Other risks in older adults:
- There is some risk of developing a problematic addiction, especially if there’s a prior history of substance abuse. But in my experience, having someone else — usually younger — steal or use the drugs is a more likely problem.
Where to Learn About Other Drugs That Affect Brain Function
Many other drugs that affect brain function, but they are either not used as often as the ones above, or seem to affect a minority of older adults.
Notably, there has been a lot of concern in the media about statins, but a meta-analysis published in 2015 could not confirm an association between statin use and increased cognitive impairment. In fact, a 2016 study found that statin use was associated with a lower risk of developing Alzheimer’s disease.
This is not to say that statins aren’t overprescribed or riskier than we used to think. And it’s also quite possible that some people do have their thinking affected by statins. But if you are trying to eliminate medications that dampen brain function, I would recommend you focus on the ones I listed above first.
For a comprehensive list of medications identified as risky by the experts at the American Geriatrics Society, be sure to review the 2019 Beers Criteria.
You can also learn more about medications that increase fall risk in this article: 10 Types of Medications to Review if You’re Concerned About Falling.
What to Do if You or Your Relative Is On These Medications
So what should you do if you discover that your older relative — or you yourself — are taking some of these medications?
If it’s an over-the-counter anticholinergic, you can just stop it. Allergies can be treated with non-sedating antihistamines like loratadine (brand name Claritin), or you can ask the doctor about a nasal steroid spray. “PM” painkillers can be replaced by the non-PM version, and remember that the safest OTC analgesic for older adults is acetaminophen (Tylenol).
If you are taking an over-the-counter sleep aid, it contains a sedating antihistamine and those are strongly anticholinergic. You can just stop an OTC sleep aid, but in the short term, insomnia often gets worse. So you’ll need to address the insomnia with non-drug techniques. (See here for more: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.)
You should also discuss any insomnia or sleep problems with your doctors — it’s important to rule out pain and serious medical problems as a cause of insomnia — but be careful: many of them will prescribe a sleeping pill, because they haven’t trained in geriatrics and they under-estimate the risks of these drugs.
If one or more of the medications above has been prescribed, don’t stop without first consulting with a health professional. You’ll want to make an appointment soon, to review the reasons that the medication was prescribed, alternative options for treating the problem, and then work out a plan to reduce or eliminate the drug.
To prepare for the appointment, try going through the five steps I describe in this article: “How to Review Medications for Safety & Appropriateness.”
I also recommend reviewing HealthinAging.org’s guide, “What to Ask Your Health Provider if a Medication You Take is Listed in the Beers Criteria.”
Remember, when it comes to maintaining independence and quality of life, nothing is more important than optimizing brain function.
We can’t turn back the clock and not all brain changes are reversible. But by spotting problem medications and reducing them whenever possible, we can help older adults think their best.
Now go check out those medication bottles, and let me know what you find!
You can also learn more about getting memory concerns evaluated in these articles:
- Q&A: How to Diagnose & Treat Mild Cognitive Impairment
- Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
We are at 200+ comments, so comments on this post have been closed. If you have a question about your medications, we recommend consulting with your usual health provider or discussing with a pharmacist.
Comments
Doctor,
Great article! Your insights are extremely valuable and are greatly appreciated. Thank you.
Thank you, glad you found this helpful.
Hi, I realise that I am responding to a rather old article but below I have posted a link to the BBC website regarding the possible use of trazodone in the treatment of Neurodegenerative diseases.
https://www.bbc.com/news/health-39641123
Interesting. It looks like the studies so far have been done in mice. We do use trazodone in geriatrics as a mild sleeping aid; at low doses it seems to be less likely to increase fall risk than other sedatives are. It has also been used to treat sleep difficulties in people with dementia.
How to Manage Sleep Problems in Dementia
Hello, I take 50 mg of Trazadone for sleep. I’m very sensitive to drugs and would like to stop taking it but I so scared of the withdrawals. I also suffer from anxiety. My doctor wanted me to take 1/2 Trazadone and half Visteral. Will I have dark side effects doing that vs going st a slower pace?
You don’t say how old you are, but Vistaril is quite anticholinergic, so in geriatrics we would often consider that riskier for the brain than continuing trazodone.
If you have anxiety, it may be helpful to ask your doctor for help finding cognitive behavioral therapy or other non-drug approaches to help you manage anxiety symptoms.
In terms of tapering medication, slower is often easier for people to tolerate. Another approach is to try what the doctor recommends but then speak up right away if you experience withdrawal, so that they can adjust your dose and slow the taper. Good luck!
Trazodone is horrible. I took it for a while some years ago. It has alpha blocking abilities which led me to have terrible nasal congestion. I had to use nasal sprays to even breathe. Weaning off the nasal spray was a bear. I wouldn’t recommend trazadone to my worst enemy.
Sorry to hear you had such a bad experience with trazodone. My experience has been that most people tolerate it pretty well, but of course everyone is an individual and so in some people, just about any medication can cause significant side-effects.
FWIW, many medications are alpha blockers, which means that they interfere with the constriction of smaller blood vessels (or even the urethra, which is why they are used to help older men pee). More on alpha blockers is here.
I take trazodone daily and for me, the benefits outweigh the downsides. It relieves my depression and doesn’t give me insomnia like other antidepressants have. I do get some nasal congestion at night but its tolerable. My advice would be to only use decongestant in one nostril and stick with that nostril for a few days until it’s no longer effective, before switching to the other one. That way one nostril is always clear while the other one is rebounding. In my experience, one clear nostril is plenty, especially when you’re in bed.
I am very happy with Trazodone 50mg verses Activan which I was on for years because of 3 back surgeries. Not sleeping good lost husband last week today Dr increased it to 100mg until my normal sleep pattern returns. Also took me off Norco for pain as my children said I was a zombie for years . Now I take Suboxone. I’m been on this regiment for 7months and my children say They their mom back. 84years old and my mind is sharp . Also quite smoking ?8 yrs ago. I’m very proud of myself.
I am very sorry to hear of the loss of your husband, my condolences. But congratulations on quitting smoking and otherwise reducing some of the medications that were affecting your mind.
Bereavement usually affects sleep and mood, so be kind to yourself during this time of change. Good luck and take care.
Could taking muscle relaxer medications like flexeril, Skelaxin and others BEFORE a T.B I. predispose you to a worse T.B.I. outcome, such as Seizures and/or Epilepsy?
I don’t know the answer to this question. They do study outcomes after TBI but I don’t think they are usually able to account for people taking specific medications beforehand. Here is an article on TBI outcomes: Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study
I took Lamictal as a mood stabilizer for several years as a teenager. Is there any way I can understand the long term impact this will have on my memory?
You could try searching Pubmed for this. In general, we don’t have much research on the long-term “consequences” of taking these medications for years in the earlier part of life. Those are difficult studies to do and are always limited by “confounding” (meaning, people are put on medications for a reason, so when they are different from others later in life, it is hard to tell whether that’s the residual effect of the medications versus related to the reason they went on the medication in the first place).
If you are concerned about your memory or maintaining your memory, I think it’s generally not productive to spend too much time on what happened in the past. Instead I would recommend working on the fundamentals of optimizing brain health, which I cover How to Promote Brain Health:The Healthy Aging Checklist, Part 1. Good luck!
Dr. Kernisan,
Thank you so much for sharing this informative article.
My mom has had dementia for 8+ years, but it has recently gotten much worse. She just turned 90. I have recently found out many of the meds she had been taking are on this ‘list of what NOT to take for dementia’. Can you recommend a type of doctor that we could take her to see? Her primary care physician is wonderful, but I would love to take her to someone who is a specialist in this area.
I have been taking Doxepin for about 4 years now for an extreme case of itching. I now see this med is on the ‘bad’ list. I am 58, and I have noticed my memory is definitely getting worse! Could you please recommend an alternative to this Rx or a type of doctor for me?
Thank you,
Andrea
If you are concerned about your mother’s medications and managing her dementia, I would recommend seeing a geriatrician, or perhaps a geriatric psychiatrist. The only thing is that they are often in short supply. I have suggestions on finding geriatrics care here: How to find geriatric care — or a medication review — near you.
I also cover medications that are often prescribed for difficult dementia behaviors here: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.
In terms of the doxepin you are using, you may want to see a dermatologist and ask about alternative ways to manage your itching condition. It may be possible to treat it with a topical medication, or with oral medications that are not anticholinergic. There is also a possibility that if you consulted with a more holistically oriented practitioner, you may be able to reduce your skin symptoms by changing your diet and other lifestyle factors.
It is common for women in their 50s to notice changes in memory, in part because changing estrogen levels can affect brain function. Research is ongoing into this aspect of memory and brain health.
Good luck!
I must say that I think doctors are not helpful at all when it comes to insomnia, which I have. We are told that too little sleep is a risk factor for dementia. We are told that anything we use to help us sleep (except scary antidepressants) cause dementia. We are told to try sleep hygiene, which has never worked at all for me. I think physicians need to suffer the misery of insomnia before they advise patients. When I was younger, I slept like a baby. Now, sleep is elusive. You guys simply don’t know that of which you speak. If you went through this, I really think you’d change your tune. You have to pick the least of two evils. The OTC Unisom is the closest thing I have taken that works. It is a sedating antihistamine. If I have to get dementia, I’d rather get it with some sleep.
Well, I have not been an older person with insomnia and/or age-related changes in sleep. But I certainly have suffered insomnia for months on end, so I can somewhat appreciate the related frustrations (and impact on one’s daytime mood and abilities).
Sleep hygiene, used alone, is often not enough to help people overcome insomnia. Cognitive-behavioral therapy for insomnia has a better track record, as do a few other approaches. You can learn more about them here: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.
The downside of these non-drug methods to treat insomnia is that they take time and effort, but they do often improve sleep in those who make the effort. It may be worth trying before concluding that you have no choice but to accept the risk of using an anticholinergic drug indefinitely, to manage your sleep. Good luck!
Jack, I am right there with you. I am a younger person suffering from insomnia, and doctors don’t believe me when I tell them how bad it is. I’ve gotten the “sleep hygiene” lecture so many times and comments like “Just go to bed earlier” and “Get out of bed earlier.” Gee, why didn’t I think of that!? It astounds me how ignorant and insensitive some doctors can be. I finally found this one doctor who took me seriously but he has since retired. He helped me find the right medication and dosage for me that finally allowed me to fall asleep at a reasonable time. I am still on one of the same medications he originally gave me. Now, whenever I see a new doctor, I usually get “grandfathered in” to be able to stay on the medication and the moderate dosage because it is what has been working for me for so long
Absolutely agree with Jack’s comment. I’m 77 years old and have suffered many tragedies in my life (death of children, suicide of husband, just to mention a couple.) For 20 years I’ve taken .125 mg to .5 mg of Xanax nightly to get a decent night’s sleep, with no problems whatsoever. Two years I moved to a new state and obviously had to see new doctors. All physicians I’ve seen here seem to believe Alzeheimer’s is right around the corner for me if I continue to take the alprazolam. So they prescribed Trazadone (couldn’t get out of bed the next day,) Vistaril (had terrible nightmares and woke up sweating,) and then Clonodine (dry eyes for the first time in my life and didn’t help with sleep.) I don’t believe the hysteria about alprazolam and I’m suffering with all the other drugs, which are probably just as damaging.
Well, risky medications are sometimes a reasonable choice, especially if safer alternatives have been explored and tried. The key is to really consider and try those alternatives, before continuing on indefinitely with a medication known to be risky for older people.
Benzodiazepines such as alprazolam affect balance (and hence are associated with fall risk) and slow down thinking. And as you are getting older, your body and mind are becoming more susceptible to those problems. So it would be good if you could somehow work with your health providers on tapering off this type of medication. That said, if you’ve tried and it really seems unfeasible, then this may be a situation where the likely benefits of continuing the medication outweigh the likely risks.
I want to add to my comment above, as regards alleged mental decline due to long term use of Xanax (which for me I do not believe is the case at all.) I am a published writer and still writing at the age of 77. I play bridge (a mentally challenging game,) do regular brain-stimulating activities and get physical exercise. I’ve read studies disputing the “Xanax-causes-dementia” theory. Granted, I have never attended med school but I think some doctors really go overboard to avoid prescribing certain drugs that might draw red flags from their peers. CYA. I notice much more sluggish memory when I’ve taken the other drugs than with the alprazolam. Can you tell I’m a bit angry about over-generalization on the part of medical profession?
It’s true that it’s unclear whether long-term use of benzos does increase the risk of dementia or of cognitive decline. What IS clear is that benzos such as Xanax do slow down brain function, so for people who have vulnerable or damaged brains, using these medications usually leads to worse memory or thinking than they would otherwise have.
Science has proven that damage due to Alzheimer’s and other dementias usually starts 10-20 years before symptoms are apparent…symptoms really reflect the brain no longer being able to compensate for the existing and advancing damage to brain cells.
I take half a pill of Doxylamine. It really helps me but I heard that anticholergenic drugs are linked to dementia. I Feel like prescription drugs for insomnia Medications or anti depressants that have a sendative effect feel much more potent. I seem to think pretty clearly on this pill. I do feel a little tired throughout the day but nothing extreme. Do you think taking half or even a third of this pill into a tiny tiny piece of doxylamine is safe to take daily in the long run or do you think this wilk aventually cause dementia?? I would really appreciate it if you could reply. -Chase
Well, first of all everyone is at some risk for developing dementia if they live long enough, because age is one of the strongest risk factors. Studies suggest that 25-30% of people aged 85 or older have some cognitive impairment, and it goes up with increasing age.
The use of certain medications seems to increase the risk of cognitive impairment. For anticholinergics, the increased risk seems to be related to the cumulative dose. If you are taking a very small dose and not taking other anticholinergics, then you are presumably increasing your risk by just a little bit. You will have to weigh this risk against the benefits of taking the medication, like better sleep (assuming it does help you sleep better).
I suppose what I am saying is that it’s not really possible to say that something is “safe” or that certain actions will eventually cause dementia. Most people eventually develop dementia due to multiple factors, including their genetics, their environment, their other chronic conditions, and various aspects of their lifestyle. Medication use factors in also, and is something that may be easier to control than other factors.
What is most important is to make a carefully considered decision, when it comes to these medications. But it’s not possible to perfectly predict or control one’s health outcomes. Hope this helps.
I really appreciate your help and I am so much concerned about the health of my mother. I have been trying everything I can to help her but true and exact knowledge helps a lot which is available from you. Thank you so much for helping me out.
Kulbir Singh
Glad you found this helpful.
Will you comment on the use of Melatonin. I find it very helpful. I am 81 with both Lupus and Sjogrens and have been taking Plaquenil for years which has been reduced because I am now being treated for both wet and dry macular degeneration. My memory is still quite good.
I appreciate your knowledge and the kind and sincere way with which you express things.
Many thanks, Elizabeth Lucas
I’m glad you find the site helpful. Melatonin does appear to be safe in older adults and can help regulate the sleep cycle. It seems less risky than most other pharmacological options for sleep. But since it’s a supplement and poorly regulated in the US, your mileage may vary.
I have more on melatonin in this article, which also covers other safe ways to address sleep concerns 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.
I am on so many meds and some I need such as high BP meds, but these I worry about are Lexapro, thyroid, Plavix and trazadone at night because I never sleep otherwise. Should I find a geriatric physician to help me sort this out?
You don’t say how old you are, but in general, I would encourage all older adults to carefully review their medications about once a year. Here are some related articles:
Deprescribing: How to Be on Less Medication for Healthier Aging
How to Review Medications for Safety & Appropriateness
None of the medications you mention are on my “most worrisome” list, but it’s always better to be on fewer medications when possible. Also better to treat problems such as depression, anxiety, and/or insomnia through non-drug methods when possible. Good luck!
Can you recommend herbal or other “natural” substances that help with sleep and are safe with sleep apnea (which is not controlled with C-Pap, but with an oral device?
Melatonin has probably been studied the most and is generally considered safe, although I’m not sure if any special considerations exist if there is sleep apnea.
O dear. I knew I was right about these meds. What about Prilosec? It is on my suspicious list.
Got an automated call from a pharmacy that I no longer use this year; said my Rx was ready, it was Meclizine for dizzyness. The hmo / pcp doctor’s office called it in. Don’t need it, didn’t ask for a refill , did not see the doctor. Could there be fraud going on, because this is more than an error. I did cancel with the pharmacy. Should I launch a letter writing correction, or do nothing like everybody else does?
I just feel inadequate to make others do their jobs right at my age (over 65).
Those kinds of pharmacy problems are quite common, unfortunately. If you cancelled your prescription then hopefully they will not send you meclizine or charge you for it.
Prilosec is the brand name for omeprazole; this is a “proton-pump inhibitor” (PPI) which reduces acid in the stomach. These types of medication are not on the Beer’s list, nor are they thought to affect brain function.
However, like many medications, PPIs are probably over-prescribed. It does seem that they affect the body’s ability to absorb vitamin b12, calcium, and magnesium, which could certainly affect an older person’s health if a PPI is used long-term. If you’re concerned, talk to your doctor and ask for help determining the likely benefit and the likely risks for your particular situation.
What about the cough syrups? What effects do they have in terms of slowing down brain function?
It really depends on what is in the cough syrup. Dextromethorphan is a common cough suppressant, and in a study was found to affect working memory in young adults:
Effect of a Single Dose of Dextromethorphan on Psychomotor Performance and Working Memory Capacity
Some over-the-counter cough and cold medications also contain an anticholinergic medication, such as diphenhydramine, as the “PM” ingredient to help people sleep.
The moral of the story is stop medicating…. sadly that’s out of so many people’s reach. And ironically many of these links do have a cause/effect blur. My mom was a top registrations pharmacist who worked probably ten to twelve hours a day, five days a week, for many years. My hypothesis I’d love to have tested is that it seems to be those who use their brains optimally that are nailed with this torturous disease. Not the couch potatoes. I’d love to know if I’m right.
Well, I would say the moral of the story is use medications carefully, and make sure you learn about known side-effects and risks, especially if you are continuing a medication long-term.
Which “tortuous disease” are you referring to? Dementia, such as Alzheimer’s disease?
Dementia is so common overall many people who use their brains a lot develop it, and many couch potatoes do too.
In terms of what increases one’s risk for dementia: being sedentary increases risk in that it increases overall cardiovascular risk, plus is associated with other risks such as smoking, obesity, etc.
Being intellectually engaged helps maintain brain function. However many educated professionals work long hours, may not sleep much at night, and generally may live stressful lives. This is not so good for brain health.
I went through a seriously traumatic time about 18 years ago which left me a complete insomniac. I try meditating, exercising later on the day etc, but I just can’t sleep. It’s exhausting as any insomniac will know. I was prescribed DOPAQUEL and take 25mg. It’s been a life saver, but please could you advise whether it’s one of the dangerous ones and possible side effects. Thanks!
Dopaquel is quetiapine, which is usually known under the brand name Seroquel in the US. It is a second-generation antipsychotic, and is used for the treatment of bipolar disorder, schizophrenia, and sometimes major depressive disorder.
This type of drug is sedating but it is NOT FDA-approved to treat insomnia. I list some concerns regarding antipsychotics in older adults above. So yes, I would consider this drug problematic…for long-term use, usually the benefits outweigh the risks only in people with serious chronic mental illnesses (e.g. schizophenia, bipolar disorder).
If your primary diagnosis is insomnia, anxiety, or history of traumatic experience, I would recommend you ask your doctors for help identifying alternative treatments. There are probably safer drugs to help, and also a number of non-drug approaches can be effective and that’s much better in the long run.
For information on proven treatments for insomnia, see this post: “5 Top Causes of Sleep Problems in Seniors, & Proven Ways to Treat Insomnia.”
Good luck!
Great article doctor! I have bipolar 1 and am 65 so this article was very timely for me . I do take Lomictal for mood stability. I also have severe sleep apnea which did not respond to melatonin. I do use a CPAP machine but still only sleep about 4 hours a night. I have slept better with Ambien, but do not take it every night because the pharmacist advised against. After reading your article, I intend to stop that as well.
Many thanks,
Sue
You sound like you are facing some more challenging than usual considerations. I would recommend looking for a geriatric psychiatrist to help you figure out the best way to manage your bipolar disease while protecting your long-term brain health.
For the severe sleep apnea, I would try to get more help adjusting your management plan. Look for a special sleep apnea clinic near you. I attended some presentations by certified sleep doctors last year and was impressed by the specialist in sleep apnea…I don’t generally think it’s great to start with a specialist for everything, but if the initial approach doesn’t work well, you need to tap into special expertise.
Last but not least, you can talk to your doctors about whether any non-drug treatments can help you sleep without Ambien…how to replace it will depend on the specifics of why you are having trouble sleeping. I have an article on this site about sleep problems in older adults. Good luck!
Dr. Do you know any drugs besides adderall that increases brain function?
Iam on alot.
Adderall is a type of amphetamine, and is a considered a “central nervous system stimulant.” There a few drugs in this class, they are mainly used to treat attention deficit disorder and sometimes depression.
Caffeine is another well known stimulant of brain function.
Psychostimulants have sometimes been tried to treat apathy in dementia, but otherwise aren’t thought to have much of a role in helping people maintain cognitive function.
The drugs that are FDA approved for dementia have a different mechanism for potentially improving brain function, I describe them here:
4 Medications to Treat Alzheimer’s & Other Dementias: How They Work & FAQs.
If you are concerned about either your brain function or your use of medications that affect your brain, I would strongly encourage you to discuss further with your health care providers. Pharmacists are another good resource, if you want to learn more about your medications and options for switching them.
Great article Dr. Kernisan. I appreciate the information that you share. I posted a link on our website.
Thank you, glad you find the article helpful.
This site and your article are very informative. I suffer from migraine headaches and have been on Nortriptyline 100 mg and Zonisamide 100 mg for prevention for years. As I approach 50, I sometimes worry that my memory is getting worse and wonder if it could be a cumulative effect of these drugs? I also average 6-7 hours of sleep at night due to a busy work and family schedule…which could be a factor. Any thoughts or recommendations?
Thank you.
I can’t tell you specifically what to do, and also I don’t have much experience treating people your age. But here are some general suggestions for you to consider.
– Taking action to optimize brain health is always a good idea. It might help in the short-term and improves your chances of maintaining good brain function in the long term. Getting more sleep and avoiding anticholinergic medications can help, and I have more suggestions here: How to Promote Brain Health: The Healthy Aging Checklist, Part 1. The research suggests that the effect of anticholinergics is cumulative.
– Consider looking into non-drug treatments for migraine, or at a minimum ask your doctor if there’s an alternative to daily nortripyline. I don’t know much about migraines, but Dr. Mark Hyman of the Cleveland Clinic Center for Functional Medicine suggests these five steps for treatment of migraine, and Dr. Greger of NutritionFacts.org reports on research finding that powdered ginger can relieve migraines. You may want to discuss these ideas with your doctors.
– Talk to your doctor about your memory concerns. A number of common problems can worsen memory, including hormonal changes, thryoid problems, and others. Sometimes it’s also helpful to get a short office-based test of memory, to see whether your feeling of memory slipping is borne out on a short test such as the Montreal Cognitive Assessment Test. I have more on evaluating memory problems here.
Good luck and glad you find the site helpful. I think you’re right to be proactive about taking good care of your brain and also think it’s good to look into your symptoms, and ask about other ways to treat migraines.
Your migraine disease itself could be to blame for the memory concerns. Studies are showing structural changes in brains of chronic migraine sufferers. It is difficult to know whether it’s the meds or the disease itself unless you can eliminate the med in question long enough to test.
Does wellbutrine effect memory ? Are there mood stabilizers that don’t effect your memory
Bupropion (brand name Wellbutrin) is not known to particularly worsen memory. It can increase the risk of seizures but that is mainly a concern for people who are already at higher risk for seizures. For a list of bupropion side effects see this MayoClinic.org page.
You can also ask your pharmacist to inform you about possible cognitive side-effects of other drugs you may be considering for mood.
Dr. Kernisan, I am on Abilify, Cymbalta, Ambiem, risperdone, klonopin, adderal, Percocet, Maxalt, topomax, Botox, Savella and Mobic. I’ve noticed lately some memory loss and I’ve lost 50 pound since February, which my primary dr is trying to figure out right now, since my pysch dr says all the drugs she has me on I should gaining weight not losing weight. I quit smoking last year in September. I have a lot of medical and mental issue. I used to be on a lot more pysch meds but we finally these one that work that stabilized me. I hate to see that everything that I am on is on your beer list ?
That is an exceptional list of medications, so I have to assume your health problems are a bit exceptional as well.
Especially if you have unusual or substantial health issues, I’d encourage you to actively participate in your health care. Some patients find it helpful to connect with other patients who have the same diagnosis, in order to exchange information on other ways to manage the condition.
Regarding the Beer’s list, and really all medication, the main thing to remember is that the benefits should outweigh the risks, and you should have considered as many options as possible before proceeding with anything risky. For some people with certain types of health problems, taking Beer’s list medications is actually the option in which the benefits outweigh the risks and problems.
Good luck and keep asking your doctors lots of questions, as it sounds like you are doing.
Nice answer!!! Very thoughtful and nuanced.
Good article – I’m going to print out the list. My mother has mild dementia and our problem is treating her arthritis pain and neuropathy without making the dementia worse. Her doctor said that she should stop the Gabapentin because it could make the dementia worse, but now we are trying to figure out what pain medicine to take. She has been on Tramadol and I can tell that her thinking is confused when she is taking it a lot. Also taking Buspar for anxiety – don’t know if this is a good choice or not?
Although it’s always possible for people to experience all kinds of side-effects from a given medication, generally gabapentin and Buspar aren’t known to worsen dementia or cognitive function.
Tramadol does seem to make people a bit sedated and drowsy, as you’ve noticed, and of the three medications you list, I think tramadol would be most likely to cause cognitive side-effects in the average patient.
It is unfortunately hard to find an oral pain medication that is effective with neuropathy and has absolutely no cognitive side-effects.
If you haven’t already done so, be sure to ask the doctor about topical options (e.g. creams). It’s also good to ask about integrating non-drug methods to manage pain: exercise and certain types of psychotherapy can help people better manage chronic pain.
Sorry doctor all you have to do is a quick google search to see that (sometimes severe) short term memory loss occurs in many patients who take gabapentin. Your statement that it “(is)n’t known to worsen dementia or cognitive function” would seem to disqualify you as a trustworthy authority on this subject.Bob
So, I don’t generally consider a “quick google search” adequate evidence upon which to base my articles or comments.
What I meant is that in published studies and in the expert literature on this topic, gabapentin isn’t currently known or confirmed to cause dementia or long-term cognitive effects. It was not at all included in the 2012 Beers Criteria list of Medications Older Adults Should Avoid or Use with Caution. It was included in the 2015 list, in the table of medications to adjust in people with decreased kidney function.
Now, gabapentin is an anticonvulsant and all those drugs are designed to reduce the “excitability” of brain neurons, so one should expect them to cause some cognitive effects and of course some people will be very sensitive to this. In another comment, I have posted a link to a study of the cognitive effects of gabapentin in “healthy senior adults”.
It is certainly possible that eventually studies could find a link to gabapentin (or other anticonvulsants) and the development of dementia, but I didn’t find any such studies last time I searched the literature in Dec 2017. If you come across any such studies, please let me know. We apparently have different standards for what we consider “trustworthy,” but I will take a look.
Thanks for this information Leslie. I am only 48 but I have been taking gabapentin for almost a year now to help with side effects of Tamoxifen that I have had to take for three years now to prevent breast cancer recurrence. The Tamoxifen threw me into early menopause and my sleep and mood were really suffering. The gabapentin has helped me with both. My cognitive function feels a bit fuzzy in the morning but it wears off quickly. I do worry about the long term effects of taking it but honestly it has been the only thing that has worked for me. I had tried lots of other medication and I continue to run, rock climb, crossfit five days a week and am vegan. But none of the other medication or lifestyle changes was helping my sleep. This does. So I really appreciate your research on this topic. I too am going to keep my eyes open to new studies but so far so good from what I can tell.
Glad if the article was helpful. Sometimes the benefits of taking certain medications seem to outweigh the risks. What is most important is to make a careful thoughtful decision and to look into alternatives, which it sounds like you are doing. Good luck.
Agree with you Doc. Bob V was quite disrespectful there.
Thank you for your thoughtful, educated and FREE advice.
Hey doctor, really appreciate the great article and your responsiveness to comments!
My grandfather took mild doses of Ambien (~5mg) 2-3 times a week for about a year. About two months ago, he increased Ambien intake to slightly larger doses (5-7.5mg) and began to experience severe short-term memory loss issues.
We’re planning to take him off it asap and wanted advice on a couple of things –
(1) Is the memory loss reversible? What are the best remedies / treatments?
(2) What’s the quickest recommended way to take someone off the drug?
If you are concerned about his memory, then reducing his Ambien is a good idea. Be sure to talk with his doctor to get medical advice tailored to him. Tapering a sedative should be done under medical supervision, and your grandfather’s doctor can help you work out a suitable schedule. Suddenly stopping Ambien often causes “rebound” insomnia. This is hard for people to cope with, and in older adults who are having memory problems, the worsened sleep-problems can make their thinking and memory even worse in the short-term.
You will also want to ask the doctor to help you assess for other problems that might be worsening his memory, because medication side-effects are only one of many things that can worsen memory. (For more on what the doctor should check for, see this article: How We Diagnose Dementia. It lists the most common non-dementia causes of worsening memory.)
In terms of whether the memory loss is reversible: that will depend on what is causing it. People often get better after they stop brain-dampening medications, but the memory problems don’t entirely reverse in everyone. Especially as people get older and older, they are more likely to be developing underlying brain changes that will cause memory problems even if they are on no medications and other otherwise optimize their brain health.
To help your grandfather optimize his brain health, I cover a number of proven approaches in this post: How to Promote Brain Health.
Good luck!
I’m trying to get off Temazepam 15mg prescribed for me by a sleep specialist for restless leg syndrome and periodic limb movements. I also had long term pain from sciatica and persistent insomnia for years. I’m now 73 and want to stay away from the benzodiazepines. Much of my difficulty is fear of not sleeping if I give up the Temazepam. CBT might help but where can I get help?
CBT is now available online — for a fee — through two clinically proven programs that I know of: Sleepio and SHUTi. You can also ask your doctor for help finding an in-person therapist.
Regarding your sleep difficulties and restless leg syndrome (RLS): are you still seeing the sleep specialist regularly? If you haven’t done so recently, it might be worthwhile to review the state of this condition and your options for managing it. You’ll want to make sure the diagnosis is correct/still relevant, and discuss all available treatment options that might help. You may want to spend some time learning more about RLS beforehand; I don’t know much about it personally but you can learn a lot from reputable health information websites (generally run by academic medical centers or government agencies) or if you really want to dig in, you can purchase a one-week or one-month subscription to UptoDate.com, which is widely used by practicing doctors and summarizes the latest known information on how to treat most medical conditions (including RLS). Sometimes it’s also helpful to get a second opinion.
Regarding getting off temazepam, it’s certainly a worthy goal. Don’t try it on your own though; you’ll need to work with a medical professional to develop a suitable tapering plan. Good luck!
I am 62 yrs old and take Gabepentin 900 mg per day and a low dose of Premarin. I was taking a generic form of Lipitor. Started having memory problems and dr pulled me off cholesterol meds for 6 months with instructions to walk. Can’t get motivated to walk and 6 months about up. Have to go back. Worried about having to go back in it. Does name brand Lipitor cause memory problems? Also have been worrying about everything and have gained a bunch of weight. Can’t get motivated to do much of anything. I’m driving my husband crazy. Your thoughts please
If you’ve been concerned about memory problems, then I would recommend you talk to your doctor about getting a more in-depth evaluation to assess your thinking and also assess you for other problems that can cause the symptoms you describe. For instance, for the symptoms you describe could be caused by thyroid problems, other hormonal imbalances, depression, and many other conditions. I explain how we assess memory and thinking concerns in this article: What Can I Do to Treat Mild Cognitive Impairment?
Re your Lipitor, if you don’t feel comfortable going back on this medication, I recommend you discuss this with your doctor. Statins do reduce the risk of having cardiovascular events. But if you want to get your other symptoms sorted out first, you are probably not placing yourself at very high risk by taking another 6 months off the statin while you get the rest of your health concerns addressed.
You should also make sure you understand what is the likelihood that taking a statin will prevent a major cardiovascular event. (See this NYTimes article on the “number needed to treat” for more info.) For instance, in people who have already had a heart attack (which means they are at high risk), studies suggest that one person in 40 is helped by taking a statin for 5 years.
Good luck, I hope you start finding some answers soon.
I take Namenda XR for dementia is this what I am to take 2 help with my memory
Namenda is the brand name for memantine. This is a drug that is FDA-approved for the treatment of “moderate-to-severe” Alzheimer’s disease. It is often prescribed to people with earlier dementia or even mild cognitive impairment, but there’s really very little research evidence that it’s helpful in early stages. There has also been some researching suggesting it might help with vascular dementia, but again, the research is not very impressive.
I explain the drugs FDA-approved for the treatment of dementia here: 4 Medications to Treat Alzheimer’s & Other Dementias: How They Work & FAQs.
Honestly if you are looking to optimize your brain health and brain function, I think it’s more important to avoid certain types of medication and then to really focus on a healthy lifestyle and avoiding brain stressors such as anxiety, insomnia, and so forth. I explain these approaches here:
How to Promote Brain Health
How to Diagnose & Treat Mild Cognitive Impairment
Good luck!
Dr. Kernisan,
I’m 88 male and have stage IV carcinoma that is being treated with immunotherapy . I was also recently (12 months ago) diagnosed to be having Parkinson’s and have been placed on sinemet 4 tabs every 4 hours during day and nothing at night. I also take 1 cap Tamsolusin at night for prostate. I have lately begun experiencing problems relating to short memory losses that I never had before. Which of my mess do you suppose could be causing my memory loss problem. I know and understand that age is akways a factor but I had been fairly healthy before being diagnosed with a kidney related uritheleal carcinoma almost a year ago that metastasized after removal of affected kidney.
Thanks and most respectfully,
~M
Sorry to hear of your health difficulties.
Medications are a common cause or contributor to memory difficulties, but there are also many other potential causes, especially given your age and current health problems. So if you are concerned, I would recommend that you bring it up with your doctor. Your neurologist for Parkinson’s might be a good place to start.
You may also find the following post helpful, as it explains how memory complaints should be evaluated: How to Diagnose & Treat Mild Cognitive Impairment
Very interesting article. Unfortunately in the case of my mom who is getting up there in years, she has a rare disease that has required a mixture of drugs to help her with a great amount of foot pain, and other side effects, to avoid pain, bring her into more medications. She and I both know that this affects her cognitive ability and she has built up these medications and the need for them for her rare – burning foot syndrome disease. Check out the list of medications she has to take, and notice almost all of them are on the list as being a risk and problem for Alzheimer’s or dementia. She takes Fentynl pain patches, Norco, Oxybutinin (to reduce the need to urinate, as more bathroom trips cause more pain), Ativan – to calm down the nerves in her feet, and classic users of Ativan use it for mental conditions, but it’s usually limited to a months dose, and Cymbalta. The Opiods are required to keep her pain down to an average level of 7 instead of 10 flares. She still gets ten flares, swelling of the feet and bleeding from almost any moderate use. She also occassionally takes pills like an antihistimine at night Benadryl, which is bad of course and another risk. And takes blood pressure medication, perhaps the only pill not on the list. And takes Flexerol sometimes which is also on the list. She has also taken other pills very short term. With her condition, I’m under the impression her nerves were damaged. We know it was caused by symptoms related to nerve medication. Xanax caused her condition to flare in the 90’s but it didnt’ cause pain, just heat and some swelling. Risperdol caused permanent flares and damage which has happened since 2002. It totally took her out of any chance of a normal type of life. What is interesting is that she worked through many medications to get to this point with this mixture to be a baseline that helps her, but the side effects of course can be difficult. It’s actually amazing, probably due to pain and opiod tolerance how much she can take, but she is down from higher doses. As a senior she takes half doses, which makes the doses hit her system with less impact and makes her feel that she isn’t as loopy. Also some unconventional things we have tried showed some promise in masking her rare burning feet symptoms. What is really interesting but not totally confirmed and somewhat questioned by doctors is that some people, and this may be rare and extremely limited to a few people, but some people seem to have a rare case of “burning foot syndrome happen”, when they take pills directed toward the brain and Seretonin antagonists. Risperdol is an antagonist to many of the Seretonin 5ht receptors and blocks action from these, calming down or inhibiting those nerves. It’s an irreversible Antagonist for 5HT-7 (Serotonin) receptor which can control blood flow and temperature or thermal regulation. Ironically some rare and seldom tried medications like 0.5% Ketamine/1%amitriptyline compounded creams which are mixed at low doses and might help some have potentially dangerous components as well. If mySeretonin theory is really correct for these rare cases. Some reported the “mixture” of cream which helped treat some burning foot patients caused a heating up for five or ten minutes of the feet when the cream was first applied before the numbness or “high” from the ketamine affected the feet and relieved pain. Mom had reactions which matched the reactions of some side effects of amitriptyline in the cream. When we had a cream prescribed without the amitriptylin, those side effects went away. The ketamine cream caused other “weakness” but reduced her opiod dependence and caused a kind of reset making the opoid drugs more effective for up to three months after a 5 day or week trial of the cream. A very small percentage of people have reported amitriptyline as causing mild or more moderate burning foot syndrome to occur in their feet. I found on Wikepedia that amitriptyline is a antagonist for almost all the same nerve locations on the 5HT (Serotonin) sites that Risperdol affects. Except Risperdol is a irreversable antagonist to 5HT7 which amitriptyline may not be. Recently on a “burning foot” patient board (on ben’s Friends) one new person to the board reported problems related to a TriCyclic Antidepressent as well. We know from our experience which is rather unique and rare that Risperdal caused or “triggered” her permanent disability. What is strange of course when I mention the 5HT antagnist issues to one of our doctors is he said, well maybe it caused it, but it didn’t cause it to happen all over her body, mostly affecting her feet. (although she has flares and heat in other parts of her body without pain.) So he wondered why it didn’t affect her entire body and said, “maybe it affected her by triggering a disease she was prone to have.” In effect saying it affected her, but wasn’t a cause as much as a trigger for something she was genetically predisposed to, at least that’s the way I took it.
In any event a lot of these pills have rare side effects and they will be listed in the fine print. My thoughts, but this is from an extremely rare or seemingly rare condition, is if you have burning feet sensation, even mild from tricyclic antidepresents, by all means work on staying away from them and avoid Risperdone, because it may be much worse.
This of course is a really bad and rare situation, where we have an old lady isolated by extreme pain, and limited in her physical movement. The pills a very strong and rare mixture, are required to keep the pain to a kind of low level torture, but flares will still happen. And unfortunately there has been little in the way of an alternative. We have tried some odd things, like Ketamine cream and even temporary nerve blocks of the tibial nerve using an injection to numb the site as if surgery was going to happen. That to test to see if a more permanent nerve block could work, and this rare and for this rare condition. Both Ketamine and the nerve block worked. The nerve blocks were temporary. The ketamine had other side effects. The only other thing for use is possibly something like oral lidocaine mexiletine, which helps some with the “genetic” version of the disease. However that is a heart risk so we haven’t tried it, as we can’t get her off the other drugs long enough to do that risky test.
Believe it or not environmental chilling is the only thing that helps the pain, although the drugs can help. The situation for this rare condition (doctors often go their entire practice without seeing one case) is one of heavy duty drugs. Some people who have these kinds of “burning foot” problems, have it due to other rare diseases and may find relief when the rare disease is fixed. But others have it and have little or no releif. When some pills are used in a mixture, for example the muscle relaxer Flexerol was mentioned and she has taken that for another injury, those mixed with other drugs, Cymbalta, and DMX cough syrip (Tussin DM) can cause Serotonin syndrome, which is a symptom that can be difficult to tell apart from other Neuropathy (nerve damage). In the case of my mom at times the mixture of a muscle relaxant in the mix (to treat a different injury), caused some temporary cold and numbing symptoms to briefly appear in the feet, which made them cold and appear more like Raynauds syndrome, which can have numbness and cold white blanched skin patches, so some can have hot and cold symptoms. But with the rare burning foot syndrome, one will often just have hot or any activity trigger a flare, in the worse cases they are completely painful, about the equivalent to the worse pain you could get in any one location. And those with the worse case versions have really almost no mobility at all. And they just have an unending flow of drugs, to try to cope with the pain. Although they are stuck with the drugs, the cognitive and all other side effects can come into play and be a risk.
Sorry if I ended up talking so much about my mom’s condition. It’s rare and requires a lot of drugs and she ends up losing a lot of sleep which causes sleep deprivation as well. She also takes blood pressure medication. And when in a hospital visit she lost so much sleep she had very bad symptoms, also being off some of the medication (Ativan withdrawal) and this gave her delirium. One of the problems with seniors with this many problems and taking this much medication, is delerium, cognative issues from side effects and sleep deprivation can be “so much like dementia” it can be ruled as that as a kind of “catch all”. It may be a kind of subtle difference in diagnosis, but the effects can often practically be the same. My mom can slip into a delerium like state, for example lose a lot of sleep and then almost fall into narcoleptic like sudden sleep states into REM sleep. This probably from lack of sleep and drug side effects. Regardless of the diagnosis and the subtleties it can often be “if it looks like a duck, it’s a duck” mentality in the quick diagnostics that are done.
It’s really hard to be dealing and living with a couple of parents with advanced age and health problems. It’s hard to explain the general decline that people have, which may make them more messy just due to health problems of age. My dad in his early 90’s started to lose a lot of capability and aged from a person who acted like he was in his 70’s to someone in his 90’s almost overnight. He has some of the signs of cognitive and memory decline especially. So he’s showing that he can be slipping down that slope. But we are also heavily involved with trying to help my mother who is younger and an old guy in his 90’s and a son can’t barely keep up with her demands. (When you have no schedule due to pain, strange environmental demands to chill the feet, lack of movement, isolation, and people who just don’t understand how hard aging can be, it can be a lonely and difficult life.)
It’s a challenge to balance their autonomy with trying to take over and do more things. How much do you let the aging parent age and decline, because they have some of that right and want to be independent, and when do you step in as a child and try to take over more. With very long illnesses like mom’s the needs she presents are just unsustainable financially as well. You can’t hire aids and nursing homes can deal with the strange demands of a very strange and rare disease. So for some of us, the road is very long indeed. (Sorry to type such a long and rather depressing report.)
Wow, that is a quite a situation your mother is in. As you point out, her foot pain is unusual.
But the other issues you describe, including the strain of helping older parents and the catch-22s re medications and their side-effects…those are unfortunately quite common.
Sounds like you are on the right track, in that you have been researching your mom’s condition and following things very closely. Your parents are lucky to have your help.
Re taking care of yourself, managing the autonomy-vs-helping dilemmas, and the financial challenges: I would encourage you to regularly connect with other family caregivers. Don’t let yourself get too isolated or ground down.
The foot pain is probably erythromelalgia. I have it and treat it with cymbalta. It helps doesn’t fix.
Rare conditions are tricky. There is more on erythromelalgia here: Incidence of erythromelalgia: a population-based study in Olmsted County, Minnesota
Would acupuncture help a condition such as this?
This would be a question to ask of a specialist in this condition.
I am 64 years old. I took ditropan for a number of years until I switched to mybetriq about 5 years ago. Would there be last effects of the ditto pan on my brain?
Ditropan (oxybutynin) is a medication for overactive bladder which is has strong anticholinergic activity. Once you stop the medication and it has cleared out of the body, it will no longer be directly affecting the brain.
However, research suggests that past use of anticholinergic drugs does increase the risk of developing dementia. This seems to be related to the cumulative amount of anticholinergic drugs a person has taken:
Cumulative Use of Strong Anticholinergic Medications and Incident Dementia
Generally, if people are worried about their brain health or brain function, I recommend that they not worry too much about past medications, and instead focus on making sure that they are NOW doing everything possible to optimize their brain health. This includes:
– making sure they check their current medications, and minimize anticholinergics and others known to be risky for brain health
– avoid vitamin B12 deficiency
– manage and minimize sleep deprivation, chronic stress, depression, and anxiety, using non-drug methods as much as possible
I provide a longer list of recommendations for optimizing brain health here: How to Promote Brain Health: The Healthy Aging Checklist Part 1
I am 60 and have been taking oxtbutynin for 3 years and have a mci diagnosis. Are there any medications for overactive bladder that are not anticholineric ?
Mirabegron (brand name Myrbetriq?) is a drug approved in 2012 which is not anticholinergic. I don’t have much personal experience with it, as it is new.
All the other drugs are anticholinergic. Oxybutynin is one of the older ones; darifenacin and trospium are newer ones that supposedly don’t cross the blood-brain barrier as much, so it’s been hypothesized that they might be less risky. Oxybutynin also seems to cause fewer anticholinergic side-effects when it’s used as a patch or gel.
If you have overactive bladder, it might be a good idea to discuss non-drug treatments and make sure you have given them a good try. They include addressing any medical conditions (or medications) that can aggravate urge incontinence, pelvic floor exercises, bladder training, and treating vaginal atrophy (if you have any) with estrogen. You can learn more about these approaches here:
Practical aspects of lifestyle modifications and behavioural interventions in the treatment of overactive bladder and urgency urinary incontinence
Good luck!
Is topical Benadryl safe to use? My thought is that is localized and doesn’t get to the brain but am I wrong? Hydrocortisone doesn’t seem to work as well for me when I have insect bites or a rash.
Yes, a topical preparation of Benadryl is much better when it comes to brain health. It is indeed localized.
Today for the first time I heard that Dyphenhedramine is linked to a large (I read 54% on another website) increase in dementia.
Not only do I have a strong family history of dementia (my maternal grandmother, maternal aunt, and now, it appears, my mom), but of course I’ve also been taking OTC Dyphenhedramine as a sleep aid for years now (at least 8 or 9 I think.) And yes, I know they are only supposed to be for short term use, but perhaps the 27 years of smoking shows that I’m not always the first person to heed such warnings.
So…I literally just stopped taking it tonight. I also quit smoking 9 years ago (though still use the nicotine replacement gum), exercise regularly, eat really well, and now, when work drives me crazy, I try to remember that they also link complex task engagement to some brain protection (though this link does not in any way appear to be as clear as the use of Dyphenhedramine, a “class 3” anticholinergic, to increased risk of developing dementia.)
Besides the above, is there any (proven) way I might encourage acetylcholine activity in my brain? I am in my mid-50’s, pretty active, low BMI.
thanks. I’m trying not to freak out too much, but 54%….is a big number.
First and foremost, congratulations on quitting smoking nine years ago and on now taking action to identify and reduce medications that might be affecting your brain. Both are good steps to take, to protect your brain health.
The 54% statistic probably comes from this article: Cumulative Use of Strong Anticholinergic Medications and Incident Dementia. The Harvard Health blog has a good article summarizing this research here: Common anticholinergic drugs like Benadryl linked to increased dementia risk.
Research does suggest that chronic use of anticholinergic drugs increases dementia risk, but I would encourage you to not think too much about that 54% statistic. What’s done is done, now what is most important is taking care of your brain the best you can from now on.
I don’t know that there’s any way to encourage acetylcholine activity in the brain. Medications like donepezil (brand name Aricept) are prescribed to people with Alzheimer’s for this purpose, but they have not shown to help in mild cognitive impairment and so I would not recommend that someone in your situation consider such a medication.
Instead, I would encourage you to consider a more comprehensive approach to maintaining brain health. I list several ways to do this here: How to Promote Brain Health.
For you in particular, you might start by working on your sleep and your stress. Some approaches, such as cognitive behavioral therapy and meditation, can help with both.
I also think this report from the National Academies of Medicine is an excellent resource: Cognitive Aging: Progress in Understanding and Opportunities for Action. Be sure to take a look at their action guide for individuals and families; it’s short and filled with good practical advice.
Good luck!
Thank you! I will check the article out. And so far (2 nights) I’ve not actually had that much trouble sleeping. Can’t decide if that’s good or bad, bc it’s possible I took that silly medication for years needlessly…
However, about 2 months I discovered blue-light blocking glasses (9$ on Amazon!) I spend lots of time on the computer to wind down when I get home, and these glasses seem to really help with the sleep issue. So, possibly no need for other interventions.
That’s great that so far you aren’t having trouble sleeping!
Yes, there is research suggesting that exposure to computers and smartphone screens and tablets can interfere with sleep. I personally have installed a red-filter program on all my devices. I use F.lux on my computer and Twilight on my phone and tablet. But the glasses can be a good solution too.
My elderly father (92), was tragically awarded guardianship over my elderly Mom (90). My Mom has had short term memory issues for some time and yes, she took Xanax because it is very difficult living with my Dad. Right before my Dad got guardianship, he committed my Mom to a Memory Care facility for elderly persons with advanced dementia. My Mom DOES NOT HAVE ADVANCED DEMENTIA!! She always responds to memory training, which my Dad never provided for her but which she got every time she broke a hip (she’s broken both!). Now she’s a prisoner on a second floor of this (for her) horrible place and paces all night trying to get out. Her doctor is still giving her XANAX!!! I, the daughter, have no rights in this situation, but this is abuse! How can I make it clear – to whom? a judge? how? – that XANAX is destroying her brain and having her take it is abuse.
I have communicated to the guardian ad litem that Xanax causes memory loss and that I suspected that my Mom does not have dementia (because she is capable of forming new synapses) but the GAL ignored my statements.
What can I do? Does my Mom have the right not to be treated with a brain-damaging drug? Does she have any rights in this situation? Do I?
Thanks….
This sounds like a difficult situation. I think you will need to consult an elderlaw attorney in the state where your mother is located. Before you do this, you can also try to contact your local Area Agency on Aging; they may be able to point you towards less expensive local resources available to assist with your concerns. However, I believe that if a guardian has been appointed by the court system, then you will probably need to work through whichever system your state has for holding guardians accountable for health decisions.
In terms of your mother receiving Xanax, it’s hard to say whether this is grossly inappropriate medical care or not. Benzodiazepines such as Xanax do increase the risk of falls and confusion. However, in individual cases, the risks always have to be balanced against likely benefits. For instance, some people really do have debilitating anxiety or agitation when they don’t take this type of medication. Your mother’s providers also have to consider the risks and challenges of stopping her Xanax; this can be a tricky process in someone who has been taking Xanax for a while.
In short, if you are concerned about your mother’s health care and you are not her guardian or durable power of attorney, you will need to consult with an elder law attorney. An attorney familiar with elderlaw in your mother’s state will be able to advise you as to your options. Good luck!
Dr. Kernisan,
Very interesting/scary article.
I am 52 years old and have taken Doxepin, 25 mg. for 22 years. Initially it was the only medication that somewhat relieved chest and throat constriction after being poisoned by inhalation of wood stain. It helped me sleep so well, I became a bit addicted, to be quite truthful, though I would take “vacations” from it for a week or 2. I have now stopped for good.
I am terrified that I have done irreparable damage and am doomed to this frightening disease. I have spoken to my PCP about this, but his contention is that this is quite a low dose, but even so, the years of cumulative use still scares me. What is your opinion?
I know I can’t erase the past, but do you know if there are current studies being conducted to determine the reversability or other possibilities to negate the effects?
I work in healthcare and have direct experience working with people suffering with dementia, and I do hope to avoid this fate.
Many thanks,
Amy
Sorry to hear that you are so worried about this.
The past is past. What is most important is that you have stopped taking this medication now. For the future, what’s important is that you do what you can to optimize your brain health, including avoiding/minimizing anticholinergics. I have a list of recommendations here: How to Promote Brain Health.
I don’t think anyone has studied how to reverse or negate anticholinergics, so you should focus on proven ways to reduce the risk of dementia, and I describe them in the brain health article. Do try to not stress or worry too much about dementia in the future…that is unlikely to improve your brain health and might possibly worsen it. Do what you can and then accept that the future is unknown and difficult diseases — such as dementia — may or may not happen. Good luck!
I am just seeing your response, and wanted to thank you for taking time out of your busy schedule to address my concerns.
Thank you once again!
A follow up question if I might…The study that I am familiar with linking Doxepin and dementia states the cohort studied were all over age 65. Do you know if these folks had been taking these drugs earlier in their life as well as post age 65? I know they had a look back period of 10 years prior (age 55), but didn’t know if they had been using the offending drugs prior to age 55.
Thanks again!
As far as I know, most research on anticholinergics and cognitive impairment has been done in older adults, and I’m not aware of research done on people younger than 55.
If you were regularly taking anticholinergics for a while, then you may have slightly increased your risk of dementia. But since dementia is pretty common in people who live to a ripe old age, most people have a fair risk of developing it whether or not they took anticholinergics.
So really…we should all be somewhat concerned that we might get dementia, and we should all find ways to make peace with this possibility (preferably while planning ahead for the possibility, as that could really help us and our families should we develop dementia. Otherwise, we should all do what we can to optimize and maintain our brain health. Good luck!
Appreciate you working in this area. I’ve been on Prozac for years (20mg/ night) Is that a problem for the brain? I do have problem pronouncing some words here & there. Neurologist says, no issue found after MRI & Ekg?. I’ve had the problem since ’91/’92.
Also, taking Mucus Relief w/Guaifenesin (400 mg)- For mucous continuing problem. Thank you!
SSRI-type antidepressants, such as fluoxetine (brand name Prozac) are not particularly known to cause cognitive impairment.
However, we still know relatively little about what the effects — and risks — are of continuing such antidepressants long-term. You can learn more here:
Long-term antidepressant use: patient perspectives of benefits and adverse effects
If you have concerns about your memory or thinking changing, I would encourage you to keep discussing this with your doctor. Tests such as MRIs and EKGs are not sufficient; your doctors need to assess your thinking with tests for that purpose, and they should also assess you for other conditions that can cause changes in speech or thinking. I have more on how this evaluation can be done in these articles:
How to Diagnose & Treat Mild Cognitive Impairment
How We Diagnose Dementia: The Practical Basics to Know
Hi Dr. Kernison,
I am 58 years old and I was recently prescribed Dutasteride 0.5 mg for female pattern hair loss. I have been taking the medication once per day for the past several months. I have recently noticed that I have had slight memory problems that I didn’t seem to have before. Have you ever heard of this drug causing memory issues with people? I know that this drug is normally used for prostate issues in men. If this drug does cause memory issues will the symptoms go away once discontinued? Thanks!
Dutasteride is a “5-alpha reductase inhibitor,” which interferes with the body’s use of testosterone. As you note, it’s been historically used to reduce the size of the prostate, but a related drug, finasteride, is the main ingredient in Propecia, which is used to prevent male pattern baldness. The use of such drugs in women is much more recent, and as far as I can tell, not much is known about the impact on memory. Here is a recent related article:
Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review
These drugs have usually been considered “well-tolerated,” but apparently some men do experience cognitive and/or psychiatric side-effects, and these have even persisted after discontinuation in some.
Persistent Sexual, Emotional, and Cognitive Impairment Post-Finasteride
At age 58, there are certainly many reasons to develop a feeling of mild memory problems. I can’t say whether the dutasteride is likely to be the cause or not. If you are concerned, I recommend bringing it up with your doctor, and consider an evaluation for mild cognitive impairment. More here:
How to Diagnose and Treat Mild Cognitive Impairment
My mom who,is 81 was taking xanax and depakote for Alzehemiers and dementia…she declined after my sister died suddenly of a PE ..5 years ago and it has been very difficult for both of us .. These meds were making her to drowsy ,she also had restoril ordered as needed . I am a RN and when she was hospitalized for dehydration I had a geropsych Dr see her .he did a great job ,decreased her depakote to bed time only ,changed her from xanax to buspar and decreased her citalopram from 40mg to 20mg daily ,..but her kept her temezapam for sleep ..I think I don’t like mixing the buspar and restoril is to much for her. She still is to sleepy so I’m cutting out her restoril ..it would seem the buspar 5mg tid would be enough…since she has been off the xanax she has been a mean non complaint mean person…yes very mean ,,,,,.how,long will,this withdrawal from the xanax go on and shouldn’t the buspar help? I loved your article and I needed to read it ..thank,you
I’m glad you found the article helpful.
I’m not sure how much Xanax she was taking before, but withdrawal from benzodiazepines can be really difficult for people, so it’s important to do it very slowly. One approach, for helping people who were previously on shorter-acting benzos such as xanax, is to switch to a low dose of long-acting benzo, and then very slowly taper that down. However, I probably would not combine this approach with continuing temazepam — as you may know, temazepam (brand name Restoril) is a benzodiazepine too.
I have more info on tapering off benzos here: How You Can Help Someone Stop Ativan. Be sure to look at the brochure, as it shows a tapering schedule.
I also have an article on dementia and sleep problems here: How to Manage Sleep Problems in Dementia
I would encourage you to keep bringing up your questions and concerns with the geropsych provider. Buspirone can help with anxiety but as far as I know, it doesn’t have much of a role in managing benzo withdrawal symptoms. You should let your mom’s doctors know if you are worried your mom’s drowsiness, they can continue to adjust medications and try other solutions, as you are doing. Good luck!
I just saw your interview on Sixty&Me and it was so helpful. Having reached my 60s, a widow living alone, I am trying to live healthy and to be my own best advocate. I get checks for eyes, hearing, heart, etc. but there isn’t much around so you can get regular checks for brain cognition. My mother lived to 95 and there were signs of gradual loss resulting in only slight loss of cognition. However, it’s not as easy to see the signs in oneself. Your site is wonderful and a tremendous resource. It is informative and makes me far more knowledgeable when I talk with my doctor. I now know more of what to ask and what to watch for even in my own behavior. Thank you so very much!!! God bless you!
Thank you, I’m so glad you’ve found the site helpful.
Great that you are being proactive regarding your health and taking good care of your mind.
Is is possible that Lipitor is causing my 88 year old Mom problems with short term memory? She flunked the CLOCK TEST and i realize she is 88 but her long term memory is good. Doctor is advising she has dementia symptoms.
For an 88 year old with short-term memory problems, I would say it’s unlikely to be caused solely by a statin such as Lipitor.
In early Alzheimer’s and other forms of dementia, people often have good long-term memory, but they have difficulty learning/remembering new things. The clock draw test is a good one, in that it requires a fair amount of mental coordination and processing.
If you are concerned about the doctor’s diagnosis or about potential dementia symptoms, I recommend learning more about how dementia is defined and diagnosed. I have info here:
How We Diagnose Dementia: The Practical Basics to Know. Good luck!
Deat ma’am
I left ambien about 1.5 years ago and i am fine now i practice meditation and sleep well, but i guess if i am the only person who has been able to stay fine after quitting pills, is it earthly possible or have i done something strange?? I even fear if i might relapse if i am the only one
Congratulations on quitting your Ambien! If you have started a meditation practice and made other substantive changes to promote sleep, I think you’ll be unlikely to relapse.
Others have been able to taper and stop sleeping pills as well. Dr. Cara Tannenbaum of the Canadian Deprescribing Network has developed some educational brochures that were proven to help people stop these kinds of risky medications. You can learn more about them here:
Deprescribing: How to Be on Less Medication for Healthier Aging
How You Can Help Someone Stop Ativan
Thankyou ma’am and so kind of you to reply me
But i was talking about ambien and this post was about benzos, I guess ambien is more harmful than benzos
Ambien is less well studied than benzos, especially when it comes to long-term use and whether it might affect dementia risk. In the short-term, it certainly affects thinking abilities and balance the next day, even in younger people. For this reason, in geriatrics we generally recommend that older adults avoid drugs like Ambien.
Ok thankyou ma’am
But have you seen others too?? Who have been off ambien and been fine after that? May be by using meditation, or natural therapies
Yes, I have seen older adults manage to discontinue Ambien. But it’s a long challenging process for many, and is best done with some help and support from one’s doctors.
You mean managed upto several years ??
Is the brain fog something that would subside, eventually, after discontinuing Benadryl for sleep?
It really depends on what’s causing the brain to feel foggy. If it’s mostly due to the Benadryl, then it should improve after stopping this medication.
Many health problems can cause the brain to feel foggy. Sleep-deprivation and stress can also contribute.
Thank you very much for the reply.
Thank you so much for taking the time to research, write and publish your informative (and RATIONAL) articles- SO very helpful for those of us navigating health issues for our aging parents!
Best-
Kimberlee Norris
atty at law
You’re very welcome, happy to help!
Thank you for your very informative articles! Miranda Wolhuter.
A very enlightening article; one everyone should read.
Re SSRIs mentioned in your article, our family doctor recently prescribed my mom with Brintellix, which is said to be a SSRI. Starting with 5mg for trial for 8 days, and afterwards increased to 10mg each day after no side effect was shown during the trial period. Before this medication, my mom suffers from dizziness and serious fatigue almost every day with low mood. Today is the 4th day on 10mg. We observed that dizziness and fatigue issue become less serious/frequent and she restarts walking as exercise – though she feel tired after exercise each time.
Her doctor said that those physical symptoms were actually due to depression. Is it true? Will this drug impact on my mom’s Alzheimers disease?
Thanks a lot.
The tricky thing about dizziness and fatigue is that SO many things can cause them, in an older person. So, it’s important to check carefully for other medical causes of these problems, before concluding they are due to depression. Depression is also usually associated with one of two key symptoms: frequent sadness or losing interest in things that used to give pleasure.
To evaluate fatigue and/or dizziness in an older person, we often check bloodwork including a CBC, a metabolic panel, and thyroid function. (We also have to ask about concerning related symptoms using questions, and physically examine the person. I explain commonly used blood tests here:
Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults
What is good is that your mother seems to be improving. Hard to say whether it is due to her new SSRI; usually they take 4-8 weeks to have an effect.
Also, you should know that the scientific research generally finds that antidepressants work no better than placebo, for treatment of depression in people with dementia. There is an excellent review article available here:
What is the therapeutic value of antidepressants in dementia? A narrative review
In terms of side-effects or potential harms: Vortioxetine (brand name Brintellix in some countries) is one of the newest SSRIs, so it has less of a track record than some of the other SSRIs we often use in geriatrics. Here is a recent review I found, on this newer SSRI:
Profile of vortioxetine in the treatment of major depressive disorder: an overview of the primary and secondary literature
SSRIs in general don’t seem to have a big effect on cognition in Alzheimer’s, although one study found that citalopram was associated with a little additional cognitive decline (on the other hand, it also decreased agitation a bit).
However, SSRIs have been associated with increased fall risk.
So, generally I recommend people pay close attention when trying antidepressants in dementia. If the person is not clearly better on the drug, it may be safer to discontinue it.
If you become concerned again about dizziness or fatigue, I would recommend asking the doctor more questions about what else it might be, and what tests have been done to rule out other possibilities. Good luck!
Thank you so much for providing those useful articles. We will keep monitoring my mom’s condition and talk to the doctor promptly in case of any change.
Does “Gabapentin” cause problems too??
Gabapentin is technically an “anticonvulsant” (i.e. an antiseizure medication) but was heavily marketed for pain and nerve pain, and that tends to be the most common reason I see it prescribed in older adults.
Some anticonvulsants are sedating or associated with fall risk. Gabapentin seems to be “better tolerated” than most anticonvulsants, meaning it causes fewer side-effects. I don’t know of any research linking it to an increased dementia risk, but one study did find that it caused mild cognitive effects.
This is not so surprising when you think about it; the whole point of antiseizure medication is to reduce the activity of neurons in the brain.
I think the bigger problem with gabapentin is that in many randomized studies, it turns out to not be all that effective for the conditions that it is often prescribed for. In short, it seems less likely to be harmful than many medications I mention in this article, but it’s also not clear that most people benefit from taking it.
Just curious about marijuana, tryptophan, valerian, chamomile and magnesium for insomnia/anxiety. Do any of these potentially exacerbate risk for dementia?
I took a quick look in the medical literature, there doesn’t seem to be much published research on marijuana, valerian, chamomile as a risk factor for dementia.
Tryptophan is an amino acid precursor to serotonin and melatonin. I’m not aware of tryptophan supplementation being related to dementia risk; in fact this article suggests that supplementation may improve cognition (at least short-term) in some people: Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis
Some research has found that low magnesium levels are associated with a higher risk of Alzheimers, but g 2017 study found that both high and low serum magnesium levels were associated with a higher risk of dementia. This suggests that too little magnesium is a problem and that too much might be a problem as well. Whether the amount taken as a supplement, regularly or nightly for insomnia, would be a serious risk…I think it’s probably not yet known.
I comment further on the use of magnesium for insomnia here.
Probably the best and safest way to try to reduce insomnia and anxiety is to use non-drug methods, preferably in combination (e.g. cognitive behavioral therapy along with exercise and other lifestyle changes).
Excellent blog. Thanks very much. I am in the process of tapering my 83 year old mother (with mild dementia) off of Ranitidine. She also takes 40 mg of Nexium (prescribed several years ago for acid reflux) and 12 hour Allegra (Fexofenadine) twice daily. I see that Fexofenadine is listed as “controversial” on the drug list. Should I speak to her MD about moving her to Claritin or another alternative? What about the Nexium? Once she is off of the Ranitidine, I would like to slowly taper her off of the Nexium to see if she really still needs to take it. Thoughts?
She has been taking 4 mg of Medrol daily for 2 years which her internist believes helped her cognitively. We have been working with a rheumatologist to taper her off of the Medrol because we believed it contributed to her muscle weakness, recurrent UTIs and speaking issues. Now down to 1 mg and her muscles are much better. Does long term use of 4 mg of Medrol daily contribute to her dementia issues? Alternatively, have you heard of Medrol (in that dosage) helping with dementia – i.e. more alert, etc….? She has good long term memory (short term memory is shot) and needs round the clock care but is aware of everything going on despite inability to express herself.
I’ll start with the Medrol question. This is methylprednisolone, a glucocorticoid (also known as a type of steroid), very similar to prednisone. Glucocorticoids are potent anti-inflammatories. By far the most common chronic use is to treat auto-immune diseases, but they do cause quite serious side-effects when used chronically, including some of the problems you mention.
Prednisone and other corticosteroids
Honestly, I have never heard of glucocorticoids being used to improve cognitive function, in fact they are known to cause a variety of cognitive and psychiatric side-effects. If your internist has recommended this, I would suggest asking him or her to provide you with information on why they believe this is likely to be helpful. I just took a look in the literature and couldn’t not find any justification for such an approach, but it’s possible that there are other aspects of your mother’s health history that might justify such an approach.
Psychiatric complications of treatment with corticosteroids: review with case report
Glucocorticoids do need to be tapered down carefully, once a person has been taking them for a significant length of time; rheumatologists are usually quite experienced in helping people taper these medications.
Regarding the treatment of potential GERD (gastroesophageal reflux disease), you may want to ask the doctor why she is on both ranitidine (a histamine 2 receptor agonist) and Nexium (a proton pump inhibitor). Usually something like ranitidine is used for mild cases, and studies find that it declines in effectiveness in people who use it continuously. For people with severe or persisting symptoms, a PPI such as Nexium is more commonly used. PPIs have been associated with concerning health outcomes in older adults, although there’s been some debate about how serious these are in most people.
Here is a good brochure about tapering PPIs, from the Canadian Deprescribing Network:
You may be at risk: You are currently taking a proton-pump inhibitor (PPI)
For more on treating GERD, here is a review article from the Cleveland Clinic:
GERD: Diagnosing and treating the burn
It would likely be reasonable for you to review her GERD history with her doctors, to make sure she was correctly diagnosed and that you’ve considered all available lifestyle treatments.
In terms of her Allegra, you could certainly try switching to Claritin or a nasal steroid. But I would say it’s a higher priority to help her taper the Medrol (assuming that is what you decide to do, and I would only recommend continuing such a high-risk medication if there were very compelling reasons to do so).
Generally it’s best to work on changing one medication at a time, especially in people with dementia who may have difficulty expressing any changes in symptoms clearly.
I do think it’s good that you are revisiting the purpose and value of all her medications. Good luck shepherding her through this process.
It seems the sooner canabis is legalised and proper use of it is made, especially for older people who are often taking cocktails of drugs from their GP, some of which are to treat side-effects of others. With no side effects and a range of conditions cannabis can treat, including; glaucoma, depression, nervousness, insomnia, various kinds of pain, not to mention cancer, epilepsy and and other conditions now being investigated by cannabis researchers.
Seems to me the perfect drug for the old. Only pharmaceutical companies would lose out, which is probably why they have been both spreading misinformation about cannabis while at the same time racing to develop ‘proprietary’ medicines using the cannabinoid active ingredients which they are unable to patent, being a natural plant that grows as a weed on every continent.
I agree that cannabis could be promising, but first I would want to know more about the long-term effects on older adults, esp as regards memory, thinking, and falls. This is especially important if the situation suggests a person might take the medication for years.
Historically most research on cannabis has been done on younger people, but now research is starting to be done on older adults.
Marijuana Use in the Elderly: Implications and Considerations
The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative?
Hopefully, more research findings will become available in the next few years.
What about melatonin for sleep problems? Is it safe?
Melatonin does appear to be safe. I have some more information about it in this article: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.
Hi, I got diagnosed with Bipolar disorder in 2014 after a break with my fiance, I went to the doctor and told him I am depressed and he gave me antidepressant after that I went into mania and psychosis…I got started with Olganzapine for 1 year, after that I tried to stop smoking cigarette I asked the doctor and he gave me Chantix I again went into Mania and psychosis….than I became fine and started having lamictal which use to make me high and I went to the doctor again and asked them to help me stop smoking and he gave me Zyban…zyban again took me into mania and psychosis and I suffered again….for the past year I have been on Carbamazepine and Dapakon 1000 mg and 200 mg, but when I stopped 200 mg and had Zolpidem cause I couldnt sleep I went straight into mania and mild psychosis….I have had 4 episodes because of medicines…I have realised that ANY MEDICATION WHICH SSRI Or Antidepressant is like poison for my mind…….I am on two mood stabilisers is it effecting my mind and will it effect my memoryin the long run???
So, you have a dignosis of bipolar disorder and it also sounds like you’ve been having a lot of mental health symptoms recently. So weighing the benefits and risks of mood stabilizers is different for you than for many older adults, who are usually given these drugs to manage difficult dementia behaviors.
You don’t say how old you are, but for people with significant mental health issues, what is usually most important is to stabilize their symptoms, to avoid mania and psychosis. Once you are stable, you will be in a better position to talk with your psychiatrist (and perhaps get a second opinion) regarding the long-term risk of your medications and what alternatives might be available.
Studies done in Taiwan found that lithium treatment was not associated with increased risk of Alzheimer’s disease whereas treatment with valproic acid was. A psychiatrist or other expert should be able to help you delve further into the related scholarly literature. But again, I would encourage you to first focus on stabilizing your symptoms. Good luck!
I had problems with lyrica. I could t remember the simplest things, had difficulty putting sentences together, would space out for short periods of time and was often confused. When I stopped lyrica and changed to neurotin the problems stopped. the lyrica was better for pain but unfortunately not for my brain..
Pregabalin (brand name Lyrica) is an anti-convulsant drug that is prescribed to treat a variety of conditions, including nerve pain, fibromyalgia, and anxiety.
It is known to cause short-term cognitive side-effects in a fairly substantial proportion of users. It has only been used in the US since 2005 and so as far as I know, it’s too soon to know if it’s associated with longer-term cognitive risk.
You mentioned sedating antihistamines which should be avoided for Alzheimer’s patients. My mother who has Alzheimer’s disease was prescribed with some medicines by her family doctor for addressing running nose and serious cough. We are told that some pills are antihistamines and will make her feel drowsy/sleepy. In fact, my mother talked in the dream and sometimes had hand movements. Are these pills sedating antihistamines? I can’t find any information the Internet that explains whether or not the pills are sedating. Is there a full list that shows this important formation? The name of the pill on the package label is Slow-Theo. Do you have any idea? Thank you.+
Slow-theo appears to be theophylline. It is not a sedating antihistamine. This is a drug that is no longer used very often in the US, and is FDA approved for the treatment of asthma and COPD. I believe it’s not sedating, instead it’s a bit activating and stimulating, and actually can cause arrhythmias, insomnia, tremors, and other “excitatory” type of side-effects. It is on the Beer’s list of medications that older adults should avoid or use with caution.
Thanks for the article. I am so disheartened to find out that Trazadone is an anticholinergic. I have chronic problems with insomnia despite working out a lot and following all the other sleep hygiene practices. Is there something I could take to mitigate the harmful effects of Trazadone? Is it ok to take if I stop for several months at a time? Is melatonin harmful? It doesn’t work as well for me but maybe I should try it again.
Thanks for entertaining my questions.
So, according to the list of anticholinergic medications that I link to in this article, trazodone is classified as having “low” anticholinergic activity.
In geriatrics, we usually focus our concern on the medications that are in the “medium/high” anticholinergic activity column. We do actually prescribe trazodone sometimes; of all the medications that are sleep-inducing, it seems less likely to harm than our other options.
But of course, the best is to help a person sleep better without using any medications. Melatonin does appear safe, but since it’s a supplement and poorly regulated in the US, your mileage may vary. Otherwise, for non-drug ways to sleep better, you might want to try a cognitive-behavioral therapy program for insomnia (CBT-I). Even the online programs (Sleepio, SHUTi) have done well in research studies, and they seem to be more effective than sleep hygiene alone.
Good luck, I hope you find a way to sleep better soon!
Your response is very helpful. Thank you so much for being so accessible for questions. I am 54 years old, and have friends in the roughly the same age range who all take trazadone. So are you saying it is fairly safe to take on an on-going basis for women in our age range? Also, one has a brain injury from 20 years ago. She has a lot of difficulty sleeping bc of it and was recently switched to trazadone. Are there any special considerations in taking trazadone on an on-going basis when you have a brain injury? She has to avoid over-stimulation and get extra rest, but otherwise she functions fine.
Thanks again for your valuable perspective.
Honestly, I think we don’t really know how safe it is to take trazodone long-term. In geriatrics practice, we consider it safer than most alternatives (with the exception of melatonin). However, our patients are considerably older than you are, so we don’t have experience with what happens when people take trazodone for 20 or 30 years, and the considerations when prescribing medication are different when people seem to have a more limited life expectancy.
What is known about trazodone and other sleep medications for older adults is summarized here:
Review of Safety and Efficacy of Sleep Medicines in Older Adults
If your friend has a history of traumatic brain injury, she may want to consult with a clinician who specializes in the long-term care of such people. Again, I doubt there is actual published research on trazodone in people like her, but she could check PubMed or Google Scholar and see if something turns up.
Again, the safest option is always to find ways to resolve or manage insomnia without medication. Good luck!
Hi Dr. Kernisan, I am a 63 year old female, still working, and healthy other than difficulty staying asleep all night. I took Flexeril 10 mg 3-6 nights per week for the last approximately 10 years, and it worked great for keeping me asleep all night. I don’t take any other prescription meds except bio-identical hormone replacement. Now my doctor is weaning me off the Flexeril because of the anti-cholinergic issue, and the problem of sleeping all night is back with a vengeance. I am putting myself through a trial of a number of herbal sleep aids, in addition to all the other helpful recommended practices. I have a very demanding professional job with long days of focused concentration necessary. I need to work at this pace for 3 more years to have a retirement where I can afford good health care. Would Trazadone be an option? I am assuming it is less than a problem than Flexeril. I’ve tried many herbal remedies that have been recommended and nothing has worked so far. I’m getting anxious that I will not be able to sustain my productivity and will jeopardize my financial retirement goals. Do you have any advice for me? Thank you! With appreciation, Hannah
Trazodone is a medication that geriatricians use more than the others, as it seems to have less risks for the brain and balance than other sedating medications. It is much less anticholinergic than Flexeril.
It sounds like you are trying a variety of recommended practices to help you sleep. I would encourage you to consider cognitive-behavioral therapy for insomnia (CBT-I) if at all possible; it has a good track record in studies and even the online programs seem to work. It should help, among other things, with that anxiety about your productivity and your finances.
You could also consider whether it’s possible to implement certain approaches during the day to maintain your mental productivity, such as short naps (even if you don’t fall asleep, 20 minutes with your eyes closed usually refreshes the mind) or a short walk outside. Many of us — myself included — have a tendency to remain doggedly chained to the workstation all day, but that’s often counterproductive. Good luck!
I was surprised to see the relatively low risk (in this context) you assigned to the opiate pain meds. Two years ago my then 92-yr-old Mom was prescribed a 3-week round of oxycodone after a fall that strained her back and dislocated her shoulder, tearing the rotator cuff on her non-dominant side. The opioid kept her pain-free and “content” but left her in a fogged state that took several months to mostly clear before she could return to something close to her former activity and independence levels.
We attributed this lengthy period of lingering cognitive impairment to the opioid meds effects on her brain, but from the assessment in your section on the opioids in this article, I would not expect such significant lingering effects. Certainly while she was taking the pain meds, she became very dependent and had little or no interest in or motivation towards the kinds of activities that she had been used to filling her days with. Was our experience atypical? Your answer could affect my attitude toward future use of these drugs, should the situation arise.
Your website is a real find – thanks so much for what you’re doing.
Glad you find the site helpful.
I am not sure I entirely understand what happened to your mom. It sounds like she was dependent and unmotivated while taking opioid pain medications after her fall, and then that even after she stopped the medications, it took her a while before her mental state completely cleared.
Some people certainly do get quite foggy when they take opiates, but no, I would not expect a lingering effect for weeks or months.
I actually wonder if your mother wasn’t experiencing some slowly resolving delirium. It would be very common for a 92 year old to develop delirium when hospitalized for a fall and injury, both due to the pain and due to the stress of hospitalization. This DOES take weeks or months to slowly resolve in some people, especially those who are older or frailer. You can learn more about delirium here: Hospital Delirium: What to know & do
By the way, although delirium often manifests as extra confusion and agitation, it can also present in a “hypoactive” form in which people are spacy, inattentive, and quieter than usual.
In terms of using opioids in the future: obviously they have to be used with great care, especially given the escalating crisis of overuse and abuse. But we do not have many safe choices of painkiller in older adults, and sometimes people do have significant pain that requires treatment. Judicious use of opioids is a reasonable option, in some cases, and then it’s important to follow each individual carefully to make sure the side-effects aren’t intolerable. The goal is for the benefits to outweigh the side-effects and risks. Hope this helps.
Hi, I’m 19 and on Fluoxetine 10 mg and on Trazodone 50 mg. I’ve started taking these last month but over the last week I’ve noticed I’ve hard a hard time rembering anything. I forget what I’m doing, and it’s really bothering me. Do you think its the medication that could be causing this?
I can’t say what is the cause of your symptoms, but it certainly is possible that these new medications might be related. You should bring up these issues with the prescribing doctor. You might also want to ask about non-drug options for treating whatever condition these medications were prescribed for.
I am a 74 yr young female and I have trouble finding my words. I do not wish to get Alzheimer, actually I am afraid of it. I also have a memory problem(not real bad) and I fall occasionally. Will cognium help me?? I take Vitamin D , Blood pressure pill, a daily Aspirin, and Paxil. Are these meds that forbidden?. I had foot surgery last year and it started right after that. Before I was fine, and quite intelligent. Could the surgery have something to do with it >
I appreciate your answer
Paxil is anticholinergic, more so than the other SSRI medications in the same class. You may want to ask your health providers about switching to something less anticholinergic.
If you are concerned about your memory or thinking abilities, then it probably would be a good idea to bring this up with your health providers. They can do some additional assessments to determine whether this falls within “normal aging” changes (it’s normal for it to take longer to come up with a given word as people get older) versus something more substantial that might indicate mild cognitive impairment, or another condition. You can learn more about the evaluation here:
How to Diagnose & Treat Mild Cognitive Impairment
It is actually not uncommon for older adults to develop some cognitive changes after surgery, it is sometimes called postoperative cognitive dysfunction.
Cognium appears to be a “brain boosting” supplement, it is not a proven treatment in humans; as best I can tell a silkworm protein has been studied in mice.
I would also recommend bringing up your falls with your health providers. Falls can be dangerous and may be the sign of a condition that needs attention. It’s also usually possible to reduce fall risk with the right interventions. More here:
8 Things to Have the Doctor Check After an Aging Person Falls
Good luck!
Any issues with neuropathy medications like Neurontin? Also LDN (low dose Naltrexone)?
Neurontin is the brand name for gabapentin, an anticonvulsant that has often been prescribed off-label to treat various types of pain. Please search this page and you’ll see that I’ve already addressed questions regarding gabapentin in a few of the comments.
Naltrexone is an opiate antagonist (it blocks the opioid receptors in the body). Historically it’s been used to treat substance use disorders, but in more recent years, low dose naltrexone is being studied for the treatment of certain pain and inflammatory conditions. It is too soon for there to be much of a safety track record in older adults or others.
Why was there no mention of cholesterol lowering drugs? Cholesterol-lowering medications might just be the single worst group of drugs for your brain.
Memory loss is now required to be listed as a side effect on the label of statin cholesterol-lowering drugs like Lipitor and Crestor.
And it’s not just statins, other kinds of cholesterol-lowering drugs were also strongly linked to increased forgetfulness.
Actually, there are a few paragraphs on statins in the article, please take a closer look.
The statin issue is tricky to sort out. Statins are associated with better outcomes in many ways, but may cause cognitive symptoms in certain individuals. This recent article summarizes the evidence on multiple fronts:
The role of statins in both cognitive impairment and protection against dementia: a tale of two mechanisms
If someone is concerned that their statin might be affecting their cognition, it would certainly be reasonable to try stopping this type of medication.
I am 67 years old and have multiple sclerosis. 5 years prior to my surprise diagnosis my GP gave me a prescription for cyclobenziprene for my back pain. Apparently, I have a mix of MS back pain and degenerative changes. After I saw the drug on the possible list of dementia causing drugs, I asked my neurologist to switch me to baclofen. Unfortunately, he has advised me to stick to 5mg 3 times daily until October. I am in horrible pain and he has advised me to take amyltriptiyline and valium. They seem like poor choices to me. There seems to be little out there for MS neurological pain. Can you please give me some advice? I have tried medical marijuana. It makes me sleep, but I continue to have pain.
Sorry to hear of your condition and your pain. I don’t have much experience managing multiple sclerosis and related pain syndromes. Presumably, some MS pain is related to the nerves themselves (often called “neuropathic pain”) and some pain is related to muscle spasms (“spasticity”).
Amitriptyline is sometimes used to treat neuropathic pain but there are alternatives. Diazepam (brand name Valium) is sometimes used to treat muscle spasticity but there too, there may be alternatives to consider. Here are two scholarly abstracts addressing pain in MS:
Identifying and treating pain caused by MS
Advances in the management of multiple sclerosis spasticity: multiple sclerosis spasticity guidelines
Honestly, I can’t say what medications would be a better choice. Many of the options will be anticholinergic or carry other risks. In general, benzodiazepines like Valium are more habit-forming and harder to discontinue than most drugs, so that is something to keep in mind.
Two things that might help:
– Join an online community of MS patients and learn more about what is helping them with pain
– Consider enrolling in some kind of comprehensive program on coping with chronic pain, such as this Chronic Pain Self-Management Program developed by Professor Kate Lorig and her colleagues. Self-management programs have a good track record and usually help people identify non-drug pain management methods that can complement medication, and perhaps enable you to get by with less pain medication.
You are in a tough situation. Get support and good luck!
Hello Dr. Kernisan, Recently there have been reports of THC helping people with dementia. Are you aware of any of the studies and if yes have there been documented long term results?
THC is being studied in people with dementia but I’m not aware of any compelling positive results so far. (I see there have been some promising studies in mice!)
A 2017 review concluded that “The current available evidence is weak and limited. It would be premature that cannabis and related compounds have any effect on dementia progression and symptoms.”
A placebo-controlled trial published in 2015 was negative, but notes that THC was “well-tolerated”:
Tetrahydrocannabinol for neuropsychiatric symptoms in dementia: A randomized controlled trial
If you know of other reports that are more promising, perhaps you can post a link here.
How is Trazadone on memory?
Please read through the comments, as trazodone has come up a few times and I have provided relevant information and links. You can search the page for trazodone to find the relevant comments quickly. The best is to use no sleep aids at all, but in geriatrics, if we are going to prescribe something, we generally consider trazodone safer than many available alternatives. Melatonin may be safer still, but it’s a poorly regulated supplement in the US.
Dr. I am using ativan for neck pain after whiplash accident about 7 years ago. I take a 1mg pill 3 times day, morning, afternoon and at night.
I started with 1 mg per day. The 3 mg is not helping any more. I am dizzy, have hair loss and severe cramps over head into the left eye. At night I suffer from severe bruxism. I have read many articles about ativan and think all these problems are caused by my medication. My dr believes in ativan and simply wants to prescribe more.
I have now started reducing my dosage and am taking about 1 and a half mg, but I am suffering a lot. I have tried cannabis oil, which has become availalbe in South Africa. But I am not having a positive result so far.
Can you please give me any advice.
regards
Heila
Sorry to hear of the difficulties you are having. I can’t say whether your symptoms are due to your Ativan or not, but in most cases, there are a lot of benefits to older adults reducing or tapering off benzodiazepines, and it’s often possible to find other ways to manage their symptoms.
In terms of tapering, it’s important to go slowly, because otherwise you will experience withdrawal and that could aggravate any chronic pain or other issues you have.
I would also encourage you get a comprehensive evaluation to rethink why you are having symptoms such as dizziness, hair loss, and headache. It’s possible it’s related to your previous whiplash or your medications, but it’s best to be checked for other causes before coming to that conclusion. You may want to try getting a second opinion, it can be good to get a “fresh” opinion on one’s medical situation. You might also want to get a second opinion on managing pain (sounds like they think it might be neuropathic in origin).
Lastly, I would encourage you to look for a comprehensive program to help you better manage chronic pain. Something similar to this might help:
Chronic Pain Self Management Program
good luck and take care!
I’ve been taking Metoprolol for about 4 years now. I only take 12.5 mg every 24 hours. The only side effect I ‘ve been having is short-term memory loss. This is driving me crazy! Is there any other medication I can take that will not cause short-term memory loss but yet control my blood pressure? I’m 58….
Thanks
Anthony
So, there certainly are other types of BP medication to consider, in fact metoprolol is not usually considered first-line for people who have garden-variety high blood pressure. (A beta-blocker type BP medication is mainly recommended for people with a past history of heart failure or coronary artery disease.) So, esp if you feel it’s giving you side-effects, you could ask your health provider about switching.
Your dose is also low, so another thing to consider is could you manage your BP adequately with lifestyle changes. I explain a framework to figuring out BP management here: 6 Steps to Better High Blood Pressure Treatment for Older Adults.
You don’t say whether the memory loss is new or has been present since you started metoprolol 4 years ago. It certainly could be related to medications, but many different things can affect brain function, so if you’ve noticed changes or have concerns, I would recommend discussing this with your health provider. There may be other health issues — many of which are treatable — that are affecting your memory. Good luck!
Dear Dr. Kernisan,
I just wanted to thank you for your efforts and dedication producing these valuable articles about gerontology. I discovered your website at the suggestion of some of my patients who were bringing precise and pertinent questions about the care of the elderly.
I find your website very informative, especially for a family physician like me, involved in post-graduate research.
Sincerely,
Guy J. Nowlan MD AAFP CFPC
Hello Dr. Nowlan,
Thank you so much for this feedback! I’m delighted to be helpful and am always especially pleased when fellow clinicians find this work valuable.
Hi , I’m a 42 year old female whoms been suffering from Insomnia since my teen age years I used Benadryl & PM medications till 2007 then I was introduced to Ambien in 2006. The medication was believed to help me rest . Since 2007-2018 I switched between Restoril & Ambien. My cognitive memory has went on vacation aswell as I’m no longer able to retain short term memory events . I’ve went to a psychiatrist whom only gave me more drugs that I had to refuse due to the side effects . I want a good night sleep without drugs . What should I do ? Are their any medications which don’t impair the brain ? Giving me symptoms of Dementia ? Thank you Shannon
Most medications that help people sleep do affect brain function.
Melatonin is a little different and seems to have much less impact on brain function, but it also works less well for sleep in younger adults, unless they have jet lag or something else affecting their circadian rhythm. (Melatonin seems to be more effective in helping older adults sleep, because often that circadian signal gets a little weaker with age, or due to neurodegeneration.)
Otherwise, in geriatrics we often try trazodone, since it seems safer than the other available options. That said, I don’t think we know how safe it would be to take this medication for decades to sleep.
The safest and best approach would be to use non-drug approaches to improve your sleep, such as cognitive-behavioral therapy for insomnia and also comprehensive approaches to manage stress and anxiety. This takes time and effort to implement, but works best in the long run. Of course, before pursuing this approach, I would recommend getting a comprehensive evaluation to check for other medical problems that might be affecting your sleep, such as sleep apnea and other potential causes. Good luck!
There is an abundance of data describing drug-drug interactions to avoid, but this data becomes sketchier beyond two-drug combinations. Three or more drugs at a time — there simply isn’t enough data (coupled, of course, with nutrition and lifestyle parameters — after all, the population of the US, let alone other countries, is heterogeneous enough to blur most patterns) to form reliable, consistent conclusions. One thing is for sure, however, and that is that polypharmacy is associated with increasing dementia in nursing homes. Whatever the cause (poor communication and record keeping, patient compliance, continuation of or additional prescribing of unnecessary medications, to name a few) it is abundantly clear that the more drugs people take as they get older, the greater their risk of harm, with diminishing beneficial returns.
A large part of the problem is the constant direct-to-consumer advertising of prescription drugs in the US — nowhere else in the world, other than New Zealand, is this permitted. It is an insidious practice, often couched in statements that demonstrate “risk reduction” (when said reduction is actually relative, rather than absolute risk, two parameters that are widely misused and misunderstood) as if piling on such and such a drug will be a cure-all.
What I would dearly love to see patients, their families/loved ones, and physicians alike adopt, is a mindset of “My goal is to reduce my medications as much as possible, and implement nutritional and lifestyle changes that will help me live a satisfying life for as long a time as I have.” We’re all going to die. Giving a 90-year old nursing home patient a statin and a BP drug in order to bring pharmacodynamic markers or measured values in line with ever-widening diagnostic/target goalposts, along with an antidepressant and a sleeping pill may not be doing them any good, but it’s likely to do them a fair amount of harm. Less medicine, more health! And it is up to doctors to ask patients what their goals are and to work with them in the most ultimately constructive way, instead of hiding behind the prescription pad so they can churn through sheer numbers.
Agree that it would be good for more older adults to proactively try to reduce medication use to the minimum and manage health with non-drug treatments when possible. This is called deprescribing, I have more info here:
Deprescribing: How to Be on Less Medication for Healthier Aging
It is certainly trickier to check for interactions among multiple medications, but drug interaction checkers such as this one do allow people to enter in several medications at once.
I had chronic insomnia for most of my adult life. I also developed electrosensitivity. Research suggested turning off all electricity at night, which worked beautifully, and now I sleep like a child. However! During the years with insomnia, I began taking lorazepam and then added ambien. I’ve been taking both of these for years and am losing my memory. I assume that slowly cutting back is the right approach, but which of these should I try to cut back first? Apparently withdrawal from either is challenging. I seem to remember cutting back on lorazepam a bit, but trying to cut back on ambien was awful.
I’d welcome your response.
Congrats on rethinking your medications, I think it’s good that you are trying to see if you can reduce your use of these sedatives.
Re which medication to start reducing first, hm…you could check with a pharmacist but I believe that lorazepam has a longer half life than ambien. In general it’s thought that withdrawal symptoms are a little less intense when it comes to medications with longer half-lives. So it might make sense to start by very slowly tapering down your Ambien, but I don’t know that there is an exact right answer to your question. I would definitely recommend you discuss this with your prescribing clinician.
I would also recommend that you seek help learning other ways to treat insomnia and to fall asleep without medication.
There is more on tapering lorazepam here: How You Can Help Someone Stop Ativan. Good luck!
holy s*** I’ve been using ibuprofen PM to sleep for years!! Been wondering what’s causing my worsening memory problems and morning depression lately. I can’t seem to process new information into long term memory at all. If I don’t write something down (like the paper towel that i’ll need to buy or the name of a new TV show I want to check out) I forget it within minutes 9 times of 10. Ouch!!
Yes, ibuprofen PM contains diphenhydramine (aka Benadryl), which is quite anticholinergic. Hard to say how much that is contributing to the memory changes you’ve noticed, but generally it would be considered safest to avoid or minimize any medication that makes brain function worse. If you haven’t already done so, I would recommend bringing up your memory concerns to your healthcare providers, so that they can assess things further.
I have written a new article this year that explains the most common causes of memory and thinking changes:
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
Good luck!
Almost impossible to avoid all of these. That’s not a particularly helpful thing for me to say, so I will add that if you take a higher than recommended dose of promethazine, it can affect your memory very quickly. You’ll experience the usual effects, like drowsiness, but feel otherwise lucid, then lose your train of thought immediately. If this is not a normal thing for you, it’s quite alarming. What’s worse is an inability to backtrack to a point where you feel you might be able to latch on to the thought. It just goes.
It’s true that it can be a challenge to avoid all of these, especially for people with complicated health situations. That said, in many cases there are alternative ways to treat or manage certain symptoms, which can allow for these medications to be reduced or stopped.
I have a question because I am worrying because I have a lot of problems with my health/cognitive problems. I want to try something for my sleep problems and anxiety/mood problems instead of the zopiclon I am using now for 4 years and oxazepam for the last ten years. I have a difficult situation so I hope you can give me some advice. I have split the dose zopiclon so now I use 7.5 mg for sleep and I also use half oxazepam because I want to quit with everything. I have had premature menopause at age 35, now 41, with severe symptoms and at that age it is recommended to use hrt. I have tried different forms but it is difficult to balance my hormones. I also have chronic migraines and 24 hours a day visual disturbances and tinnitus attacks. Since quitting my menstruations I have also developed vestibular migraines or something? Sometimes I have mood problems and anxiety (result of premature menopause or the hormones I am using) If I don’t take sleep medications I sleep 5 hours and I wake up with brain fog, migraines, tinnitus. Good sleep is essentil for me. Zopiclon gave me 6.5 hours of sleep. Despite that I also woke up tired with brain fog en never felt like I had a good night sleep because of all the neurological problems. I know that symptoms won’t go away but I have to sleep a good night. I am worrying because my short/long term memory is awfull. My dr. aren’t working together. They sent me for each problem to the next doctor so I have no idea what to do. It is so complex and every dr. has his ow specialism. I want to keep my body and brains in good health. My vitamin B12 was 233 and my dr. sees no problem (range 133-600). Could you give me some advice about the following medications: – I want to try Dekamine or Topimirat for my migraines. Which one is better and safer on the long term ( I am afraid to try these because of the side effects; At the moment I have severe memory/syntax problems) My Dr. wants me to try amitriptyline but I have read about the long term effects so I don’t want to take them. – If I quit zopiclon I want to try trazodone or something else for my sleep. The stress/anxiety problems are another problem but at the moment my sleep is important for me. I would like to try Sertraline or Citalopram but these two can cause sleep problems. So I thought Trazodon could be an option or Wellbutrin for my hyperexitable brain to sleep. Do you think this could be a good option without harming effects on the brain. – Are there natural alternatives? Natural GABA or L-Theanine? Sorry for my bad English (I come from the Netherlands) and the long post.
Your situation sounds exceptionally complicated, plus you are 41 and dealing with specific issues that I don’t have particular expertise with. So I cannot comment on what medications might be reasonable for you to discuss with your health providers.
I will say that for some people who are younger or middle-aged, a more holistic “functional medicine” approach sometimes leads to good results. These practitioners endeavor to uncover the root causes of a person’s many symptoms, and then try to correct those, often through comprehensive lifestyle changes including dietary changes and other changes. You could look to see if any such providers are available in your country.
In particular, in the long run, non-pharmacological methods of managing sleep are much better and safer for the brain.
Re vitamin B12, I have an article here. For low-normal vitamin B12 levels, we often check methylmalonic acid; if that is higher than normal, that’s quite suggestive of inadequate vitamin B12. Good luck!
Thank you for the reply!
I hope you’re still watching and replying to this thread. But, I’ve been taking 20mg fluoxetine along with 100mg trazodone for about 6-8 months now and at first it felt like everything just got better in the first week. Now my depression is starting to affect me again and even though I’m finally sleeping and happy to be sleeping I’m starting to lose track of what’s a dream and what’s reality and that is not helping my memory. I also have had a lot of concussions growing up when I was in 8th grade they said I’m not allowed to play contact sports anymore. They said something about minor brain damage in the part of the brain that controls emotion. My daily memory is pretty bad as well sometimes my girlfriend will tell me that I’ve asked what was for dinner 3 times within a span of an hour or two. Im only 23 but I want to know my best options to explore to improve my quality of life in order for me to be better for my family.
Your situation sounds quite complicated and also you are much much younger than the people I usually care for. I have no idea what is the best approach to evaluating and managing someone with your history and symptoms.
I would recommend you consult with a clinician with more experience addressing mental health concerns and other possible consequences of concussions in younger people.
You might also want to look online to see if you can find a community of younger adults coping with post-concussion issues. A community of people with similar health concerns can be an excellent source of support and also ideas on how to improve one’s health problem. Good luck!
Naturally, Haldol (and the slightly better second gen anti-psychotics) and Ativan are regularly prescribed for dementia patients in just about every facility. While they can help in severe psychotic and/or dangerously aggressive behavior, they are more often used as chemical restraints to immobilize and zombify people.
We need reform and it doesn’t look like it’s coming.
I am puzzled by your friend’s reference to “dirty drugs.” The US is on a media driven frenzy war against pain relief. Worry about addiction in a dementia patient is pretty pointless, isn’t it?
My colleague’s “dirty drug” comment refers to the fact that tramadol interacts with many medications and affects brain function; it was not a reference to addiction risk. Research suggests that there is some risk of abuse for tramadol; probably less than for opiates but it also seems to depend on how the person metabolizes the drug.
Agree that addiction concerns may be less important if a person has dementia and/or limited life-expectancy. Also important to consider whether someone else in the household might divert or abuse an older person’s medications.
I noticed that you did not address the war on pain relief. That is a huge problem. I dont even know where to start, I am so angry at the direction that medicine is taking when dealing with the problems that “elderly” patients face. Often doctors hands are tied because politicians seem to be driving medical care.
Because 72,000 drug addicts killed themselves last year, often with illegally obtained drugs, the millions of people who live with excruciating pain are forced to go without proper pain relief. And to top it off, they have to pee in a cup like criminals.
In adon, we now have the Beers list to contend with. While the Beers creators preface it with discaimers…I am sure so they dont get sued…doctors are faced with trying to help their patients while being more and more limited on what they can prescribe without being sanctioned.
Glaringly absent from the top 100 drugs or any other spot on the Beers list is the pharmaceutical cash cow statins. Proven to trigger type 2 diabetes, sever muscular and skeletal pain, peripheral neuropathy and a host of other symptoms, some life threatening. Other drugs with far fewer adverse symptoms are on the Beers list and even in the top 100, those deemed so bad for the elderly that they should never under any circumstances be prescribed for the elderly. In addition, it is not uncommon for there to be no viable alternative, nitrofurontoine being a prime example.
Incidently, I am a 74 year old woman who has been taking xanax, nitrofurontoine. Oxybutinin. Cyclobenzaprine
Oxycodone and a few other drugs you mention. I have been taking them for years. Amazingly, I am not addicted nor have I suffered any cognitive decline.
By the way, if I ever do develop dementia, I want to be zombified.
Well, this is not meant to be an article on painkillers. How to manage significant pain is a complicated topic, especially now with the current concerns about opiate overuse and addiction risk. You are right that some people live with a lot of chronic pain and it has become harder and harder for them to get the medications that they may need. This is an important issue but beyond the scope of this article.
Re the Beer’s list, I know their process for reviewing medications and revising the list is very careful. The list is currently being revised again, and I have invited a UCSF colleague involved in the Beer’s list to discuss it on an upcoming podcast episode. Perhaps we can address your statin comment during the interview.
Re your preferences if you ever develop dementia, I hope you have discussed them with your family and health providers, and documented them in your advance care planning documents. By wanting to be “zombified,” I assume you mean that pain and symptom control would be your highest priority, and that you don’t mind being sedated or taking other related risks. If that is your preference, I hope those caring for you will be able to honor it.
Hello Dr Kerisan! I’ve enjoyed reading your very interesting article and the comments. I’m a 58 year old female. I take celexa 20 mg, Trazadon 50mg QHS. I have been taking HRT since I was 38 after an oophorectomy. I take estradiol 1 mg. My question is regarding the effects of estrogen on brain health. My mother and her father (my maternal grandfather) both had alzheimers. My mother had a history of heavy smoking and drinking (she quit drinking and smoking at age 63) and serax use for more that 40 years. She was on Premarin for 25 years. When she was 70 her MD took her off estrogen replacement. Her mental decline was shockingly fast and severe. There were no other changes to her medications at that time. Because of my experience with my mother and family history, I’m afraid to stop taking my estrogen. At this point, my PCP is okay with my decision. I was hoping to get your thoughts on the subject of estrogen replacement and brain health.
Glad you found the article interesting. The relationship of estrogen and brain health is pretty complicated and is being actively researched. Generally the body’s estrogen does help the brain work better, however supplementing post-menopausal women has not generally been shown to help in research studies. There may be a “critical window” during which estrogen supplementation does help, that is being researched. You can learn more about that here (esp see the section “Human studies and the critical period hypothesis”
Estradiol and cognitive function: Past, present and future
Of note, a major randomized trial published in 2016 suggested that estrogen given early in menopause vs late did not make a difference:
Cognitive effects of estradiol after menopause: A randomized trial of the timing hypothesis
In terms of your particular situation, I think that generalist clinicians such as myself probably don’t have enough research data to make a strong recommendation. (You have not gone through normal menopause, as your ovaries were removed at age 38 and you’ve been on hormones since.) A doctor at an academic medical center, who is studying this issue, would be better informed and better able to help you review the risks and likely benefits, based on what is known so far.
Thank you so much for your thoughts on the subject and the information!
Wow! There is so much great information here, and incredibly valuable and educated insight. It is easy to forget that the medications regularly prescribed may fix the problem they were intended to, but in the end simply lead to another problem. I think this is valuable for everyone, not just those in the geriatric population. Thanks for this great post and always offering such relevant and educational information.
Hi, I am a 21 year old female and I have had about 4 or 5 concussions, the first few from playing hockey and others outside of hockey, when I think I was more susceptible to getting more concussions . My last one I had was probably over 2 years ago, but I have found that I have a lot of trouble focusing, studying, reading and understanding. I now have pretty bad short term memory which makes learning difficult. I remember in high school how much easier it was for me to read, focus, understand, remember and learn things. My brain just does not function the same way it used to. I have a brain fog a lot of the time and am often fatigued. I was looking into getting an adderall prescription, but I’m not sure if a doctor would prescribe it to me. Are there other options that might help me with these issues? I just want my old brain back..
Sorry to hear of your memory concerns. Unfortunately, I really don’t know much about concussions and memory issues in younger people. I believe there are some doctors who are studying this, perhaps you can find their articles or even see someone specializing in this, in clinic. You could also try looking for an online community of people struggling with this challenge; such communities are often a great source of info and support. Good luck!
Thanks for sharing. It will really help me.
Do any of the PPI medications have anticholinegic effects?
Also would being on one increase the anticholinergic effects of other medications?
Proton pump inhibitors are not anticholinergic. As far as I know, they don’t affect other anticholinergics, but it would best to check with a pharmacist or your usual provider regarding any specific medications you have in mind. You can also try an online drug interaction checker.
What can you do if flying, going on a boat, etc makes you motion sick? I can’t fly without Dramamine.
If it is only occasional use of an anticholinergic, in a person who is not currently having memory issues, from a brain health perspective there is probably not much to worry about. In people who don’t have dementia, the risk of anticholinergic use appears to be related to long-term cumulative use.
In people who do have Alzheimer’s or another dementia, a single dose of an anticholinergic medication can sometimes make them noticeably more confused, so I would be more cautious about using motion sickness medications for that situation.
Dr Kernisan
Thank you for the article. I am a caregiver to my 89 year old mother with personality disorder and dementia. Unfortunately her geriatric doctor has prescribed several of the antipsychotic drugs that you have listed. As time goes by it’s hard to determine if her behavior is due to the medications or from the dementia. It’s difficult to find a balance between the two.
Thank you
Personality disorder plus dementia can be a really hard combo to manage medically, and even harder to care for.
Antipsychotics can be problematic but that’s usually not because they cause worse problem behaviors; it’s because they dampen brain function (which often manifests as sedation or sometimes worse confusion), affect balance, and can cause other side-effects (such as drug-induced parkinsonism). They are also associated with a slightly higher risk of death, as noted above.
It is for you, your medical team, and your mother — to the extent to which she can participate — to determine what are the priorities for your mother’s care. Often, for an 89 yo with dementia, the priorities are to maintain comfort and quality of life, and also to keep difficult behaviors in check so that family can continue to provide care (because that’s often better for the older person’s quality of life). Prolonging life is often a lesser priority for families at this point. So using antipsychotics may indeed be reasonable.
The truth is that at this point, all the options are problematic and come with downsides, and so daughters such as yourself face difficult choices, on top of all the work of caregiving and emotional challenge of seeing your parent decline over time. I wish it were possible to make this journey easy, but it’s usually not.
Good luck and take care. Remember it is ok to make choices that are better for you, even if they impose some risks or downsides on your mother. Even if she cannot fully comprehend and appreciate it, she is very lucky to have you involved.
I looked at the study, and it’s not good science. First, they were looking for a certain result, and unsurprisingly, they found it. In actual science, you come up with a hypothesis and try to disprove it. For example, could the allergies themselves, rather than the medicines, be the actual cause of cognitive decline? Second, their follow up with study subjects was insufficient, which they admit. With such a small sample of verified diagnoses, especially in such an elderly population (70+ years), some of them are going to get dementia regardless, and it’s quite possible that it was coincidence that the two variables lined up. Correlation is not the same as causality. There are more variables that damn this study. Finally, if inflammation from allergies is the culprit rather than antihistamines, you’ve just recommendede the opposite of what would help them.
It’s true that almost any peer-reviewed published study can be picked apart. That said, other published studies have also found an association between anticholinergics medication use and developing dementia. The relevant chapter of Uptodate.com, a well-respected and peer-reviewed clinical resource, says “The case for anticholinergics increasing risk of irreversible effects is probably stronger and makes more sense physiologically given the prominence of cholinergic deficits in Alzheimer’s disease.”
I believe it’s likely to increase one’s risk of developing dementia (or developing a little sooner than one otherwise would); it makes physiological sense since acetylcholine is a neurotransmitter that plays a major role in the brain and how neurons communicate.
Now, I also believe that most dementia emerges due to multiple underlying factors damaging the brain’s neurons or interfering with their function. Inflammation probably plays a role as well. Hard to say whether someone with major allergies might be better off with anticholinergics or not. There are also other non-anticholinergic ways to try to improve allergies and inflammation.
My mother took Librium for 40 years because of a severe vertigo problem. When they stopped making Librium approximately seven years ago the vertigo was no longer a problem, but she was dependent on the medication, so her doctor switched her to valium. She is now 92 and is taking 3 mg of valium a day. She has dementia, and went into a nursing home nine months ago. We tried cutting the dosage a few times in the past, but she became irritable and cried a lot. Her doctor wasn’t much help. We stopped trying to make the cuts, believing that it wasn’t right to put her through this at her age, even though we realize the valium isn’t good for her brain. My concern is that they put her on omeprazole about seven months ago because she was vomiting a lot. I have read that omeprazole will increase the amount of valium in her system. Should we be concerned about this? Her dementia is getting worse. Her doctor doesn’t seem to know about this drug interaction. Should we consult someone else?
I am also wondering, she has gained 20 pounds since going into the nursing home in April. They are monitoring this. They say it is because she is immobile, but she wasn’t very mobile before. Is this normal? I was wondering about her thyroid, but in the past they have said her TSH is normal.
I agree that for a person aged 92 who already has dementia, attempting a benzodiazepine taper can impose a lot of distress and burden. So your choice to leave her on it sounds reasonable, especially since you did attempt a reduction and it didn’t go well.
I am not aware of an interaction between omeprazole and valium, and when I looked in the online clinical drug interaction checker that I use, no significant interaction was reported. You could check with a pharmacist to double check.
Regarding the weight loss, it sounds substantial and so I agree it’s a good idea to ask her health providers to investigate further. Thyroid problems can affect weight but there are many other medical issues to consider as well. Whether to check her TSH again or not would depend in part on whether it’s been checked since she started gaining weight; if it has and it was normal, then it would be unlikely to be the cause of her weight gain. Good luck!
I was on Prozac continuously for 15 years, from age 35 to 50, for depression. I chose not to come off it because I was worried about the depression returning. I finally in 2007 felt confident about discontinuing it, which I did, and have been fine ever since. I didn’t have any memory issues while on it and I don’t have any now at 61. Has any connection been shown between Prozac and dementia?
I am not aware of any research linking SSRI-type antidepressants (a group which includes Prozac) with dementia. That said, we don’t yet have a lot of really long-term data to help us understand how 10-20 years of SSRI use in midlife might affect dementia in later life.
Hello, I was taking Gabapentin, 900 mg a day for 4 years for cervical spinal stenosis. I recently discovered it can cause memory issues, which I was having. I am now weaning off of the drug under physician supervision. Will my memory function come back 100%? I honestly thought there was something wrong with my mind, like dementia. I am 54 years old.
If you are concerned about your memory, then I would recommend either getting a comprehensive evaluation now, or waiting until you’ve tapered off any memory-affecting medications, and then pursuing more evaluation if you are still experiencing memory issues.
I don’t generally provide clinical care to women of your age. A geriatrician is not ideal for evaluating your memory concerns, because the more likely causes of memory difficulties are different for women in their 50s than women over age 70. You’re at an age when the perimenopausal transition may be playing a role in your symptoms, so you may want to look for a provider who has experience with that. good luck!
I have only just discovered your website and podcast and find them extremely balanced, knowledgeable and helpful. I wish you practiced in NYC! My 88 year-old mom has no significant health issues. She is on HTN medication for labile blood pressure and has primary thrombocytosis and is not taking anything for it at this time. She does suffer from insomnia; she is severely hard-of-hearing (all her life but worse now); and she has arthritis and is very unsteady on her feet. She does physical therapy, walks (as much as she can) with a walker. She has some mild cognitive impairment, mostly forgetting words and having trouble following complex stories. She also suffers from insomnia and depression. Her psychiatrist prescribed Xanax, which she uses very occasionally. So far, she is very resistant to anti-depressants, but if she relents, her psychiatrist recommended amitriptyline. Based on this article, it would seem that you would recommend SSRIs over tricyclics. Can you confirm that SSRIs are less likely to worsen her balance and less likely to worsen her cognitive impairment? These are her chief concerns. I am happy that she sees a psychiatrist, but I am concerned that this psychiatrist may not be up-to-date on psychiatric medications. And will you be doing a podcast or article about geriatric depression? Thanks very much.
Thank you for your comments regarding the site and podcast, I’m so glad you find them helpful.
I cannot confirm or specify what is best for your mother’s situation. What I can say is that most expert articles on the management of depression in older adults recommend starting with SSRI-type antidepressants if medication is required, because they are less likely to cause problematic side-effects.
Amitriptyline is an older antidepressant that is quite anticholinergic. Most geriatricians would be very cautious about using it in someone like your mom and would only consider it after trying SSRIs and other options. We would also be extremely cautious about using a medication like Xanax.
If her psychiatrist is recommending these medications, you may want to ask additional questions. What is this provider’s reasoning for recommending amitriptyline rather than an SSRI? Benzodiazepines such as Xanax are known to be risky in older adults, so why does this provider think the likely benefits outweigh the risks?
You could also ask the provider to review and discuss the treatment recommendations outlined in recent review articles, such as these:
Management of Depression in Older Adults: A Review (JAMA 2017)
Depression in the Elderly (NEJM 2014)
Good luck!
I have to disagree with the Trazodone. While Z-drugs have their negative side effects and interactions, has anyone seen the list of interactions and side effects for trazodone? And who shouldnt take it? 213 major drug interactions. 812 moderate interactions. Every possible side effect from nausea to chest pain and priapism. I took wellbutrin, metropolol, flomax daily. And zofran 4 to 5 times a week for nausea started taking the zofran 8 times a week to keep my food down after the trazodone. Started getting sicker, chest pains every day, uneven heartbeats, fainting spells. All the while it gave me long but unsatisfying sleep. Upped the dose to 100 mg. Got even worse, turns out all the meds i take had major interactions with trazodone. Someone should have looked it up. Also if its not recomended for people with heart disease either. It has so many warning labels, and a list of interactions a pharmacist couldnt remember to tell me. So how is it prescribed like candy but the safer Z drugs and antipsychotics are treated like poison when its clearly the opposite? Only way i even found out about serotonin syndrom, hypotention and the risk to my existing heart condition was a psychiatrist who put the pieces together.
Many medications have long lists of interactions if one looks them up. There are certainly some individuals who respond poorly to trazodone and no prescription sedative should be considered 100% safe.
I have linked to reputable resources about trazodone in other comments. Also, the American Geriatrics Society has recently released the 2019 update of the “Beers Criteria for Potentially Inappropriate Medication Use in Older Adults”. Trazodone is not on the list, whereas zolpidem and antipsychotics are.
The Beers Criteria are published following an extensive process of review of the scientific literature. Is this process perfect? Probably not, but when it comes to which medications to be careful about, I think it’s a sounder basis than relying on anecdotes or the experience of individuals.
I will be releasing a podcast episode about the Beer’s criteria later this spring, featuring my UCSF colleague Dr. Michael Steinman, who is part of the AGS Beer’s Criteria expert panel.
Thank you for this comprehensive list. I was wondering about Sudafed and any brain function affects regarding dimentia/Alzheimers? I have been taking Sudafed 12 hour so I can sleep with terrible nasal congestion from terrible cold. I also would like advice on med. for my 89 yr old mom with Nasal congestion and cough. Sounds like Benadryl & Nyquil are out! Thank you in advance!
Sudafed (pseudoephedrine) is not usually considered concerning for brain function, unless it’s also combined with diphenhydramine (brand name benadryl) or some other type of over-the-counter anticholinergic sedative.
Yes, in geriatrics we would usually try to avoid Benadryl and Nyquil. You could ask your mother’s doctor about trying something like Sudafed for nasal congestion; it should be considered in light of her medical history. Good luck!
Hi, thank you for this valuable information. I came across your article/website when I was looking for information on the long-term effects of antihistamine use. I am a 32 year-old woman who has been suffering from severe insomnia now for 6 years. The problem started when I began my graduate studies. The program is very stressful. (I also have Generalized Anxiety Disorder. I have been on many different medications through the years to treat my GAD… I could go on for pages. Basically, the benzodiazepine medications work the best for me because they also help with the nausea and vomiting that go along with my anxiety.) When the insomnia problem started, I was put on Xanax to treat both the insomnia and the GAD. The Xanax knocked me out, but I would wake up with panic attacks because the Xanax has such a short half-life. I was using antihistamines as well to help me sleep. I was switched over to Ativan, which didn’t help much at all, and then they put me back on Klonopin (which I took several years prior to that for anxiety). The Klonopin helped with anxiety but not with sleep.
I started seeing a new doctor because the other doctor was not taking my concerns seriously and didn’t believe me that I could only sleep for 2 hours per night no matter what I did. The new doctor raised my Klonopin dose and also tried me on Phenobarbital and Butisol. The increased Klonopin dose is what seemed to help the most while having the fewest side effects. So I still take that along with an antihistamine to fall asleep. Sometimes I skip the Klonopin and just take an antihistamine and some all-natural sleep supplements from a health foods store.
Anyhow, I saw a naturopathic doctor last summer who did some bloodwork to finally get to the root of the insomnia issue. As it turns out, I have high estrogen, high progesterone, and slightly high cortisol- all of which either cause or contribute to the insomnia. I’ve been taking all-natural supplements to heal my adrenal glands and to lower the hormone levels (a comprehensive adrenal support supplement, Magnesium, Milk Thistle, Flax Seed, etc.) I also added some antioxidant supplements, fish oil, and MCT oil. The adrenal support supplement has helped me the most with the insomnia problem. I think if my adrenal glands are able to heal, then the insomnia and anxiety are greatly reduced.
Despite my progress, I’m still at a point now though where I need at least an antihistamine to help me fall asleep. I’d rather risk having dementia when I’m older than sacrifice my quality of life now (and never even have the chance at having a fulfilling life). I’ve had to basically put my life on hold to deal with the insomnia issue (I am not working or going to school at the moment). Along with this though comes other stressors, i.e., financial concerns from not having a steady paycheck coming in.
After hearing my story, what are your thoughts/ what would you recommend?
Does taking fish oil and other brain-protectants offset the long-term negative effects of antihistamines and benzodiazepines?
So in general, I can’t comment much when it comes to the health problems of people your age, because it’s not where my training and experience lie.
I don’t think it’s known whether fish oil and other supplements can offset the negative effects of medications. Also, eating the right type of whole foods seems generally to lead to better outcomes than eating just an extract via a supplement. So, especially if you think you need to take medication to address your sleep issues, all the more reason to really try to eat a diet that is good for the brain.
I recently read Brain Food: The Surprising Science of Eating for Cognitive Power, by Lisa Mosconi PhD, who is associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College. This is a good resource if you want to use diet to help your brain remain resilient.
Thank you so much for taking the time to give me your feedback and for that important information! I am going to make more of an effort to follow a diet that is helpful for the brain. The book you linked to me seems like an excellent way to start.
I wrote to you in February about my mother. She is 92, and is in a nursing with dementia. I was concerned about an interaction between valium and omeprazole. You weren’t aware of such an interaction, and said to check with a pharmacist. According to her pharmacist, though there is not a major interaction, the omeprazole could make it take longer for the valium to break down in her system. She is exhausted all the time. Yesterday my father and the nurse could not wake her up after her afternoon nap. Is this something to be concerned about? Since she caught a cold over a week and a half ago she hasn’t wanted to eat. She says her mouth and throat are sore, and the food tastes horrible. All she wants are cold liquids. It seems that she is getting worse. She is now having trouble swallowing her pills, and sometimes getting out words, Maybe it is just a question of the dementia progressing, but I want to have her evaluated to make sure she is not overmedicated. It doesn’t seem normal if you can’t wake someone up. What kind of doctor can do this. A neurologist? We are not happy with her primary doctor, but haven’t found anyone better yet. Thank you for your help.
Sorry for the very delayed reply, this one slipped past me. I hope she is better by now? Being sedated or groggy could be due to the valium lasting longer in her system, but I wouldn’t expect it to cause the sore mouth and bad tasting food. You are right that it is not normal to not be able to wake her up as easily as before. For new exhaustion or difficulty arousing someone, I would generally recommend getting seen by urgent care before considering a specialty consult. Good luck and take care!
I am 37 and recently paralyzed and am taking Lyrica and Gabapentin for nerve pain and Oxybutanin and Myrbitique for bladder issues. All four have memory loss as a potential side effect. I feel like I have noticed a significant decrease in mental capacity in the last year. This was in tandem with an increases and more stressful workload, so I am not sure what the main factor is medication or stress (or both). That said, should I be worried if any side effects of these medications could be non-reversible? I am trying to taper and swap out medications, but it is easier said than done.
So sorry to hear of your recent paralysis. I’m afraid I don’t have any clinical experience or special training in addressing memory concerns for people your age. In general, we have more research data linking cumulative use of anticholinergics (such as oxybutynin) to eventual memory issues.
It may make sense to stabilize your health and pain right now, and then later work on a more comprehensive approach to managing your health issues without (or with minimum doses) of medication. There often are non-drug options to treat chronic pain, but they can take some time and effort to implement.
You might also want to look for an online community of people with paralysis and related issues, to get moral support and ideas on how to minimize your use of medications that affect your brain function. Good luck!
I take 1/2 of a 25 ml of Hydroxyzine to fall asleep once in awhile, maybe once every 2 months. I know its not alot but I always worry about dimentia. Should I be concerned taking this small amount?
Is there a safer med that helps for falling asleep?
A half-tablet of hydroxyzine every 2 months does not sound like a lot to me, and may not be worth worrying about. That said, there are other options you could consider, to address sleep issues. I cover the safer insomnia treatment here: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.
I find that drinking a concentrated form of good quality chamomile tea is very effective for me in helping me fall asleep both at bedtime and when I wake up during the night. I’m concerned about the long term use of this practice and would like your comments.
Chamomile tea sounds quite safe and I’m not aware of any concerns. Great that you’ve found something that helps you sleep, much safer than using prescription or over-the-counter drugs for this purpose!
I haven’t reviewed all the comments on this topic, but wish to submit my experience with Trazodone. It was prescribed a couple of months ago to deal with a bout of severe insomnia, combined with depression, due to a family situation. I don’t like to take prescription drugs, but I was desperate. The first few days were promising. Traz broke the cycle of insomnia, but the effect didn’t last more than a few days. Then I was back to sleeping for a couple of hours, then awake for a while, repeatedly through the night. The most difficult side effect of Traz is that it almost completely wipes out my memory! I mostly quit taking it, but will occasionally take 1/2 tab if I really wish to sleep well, but then I encounter situations, such as at work, where I can’t remember something I did just the day before. I don’t trust this drug, and based on my experience, physicians should also not be so trusting in the hype the manufacturers are spreading. My doctor said repeatedly that this was a safe medication. i don’t think so. I like to know what I did yesterday. From my experience, Trazodone doesn’t let me.
Thanks for sharing your story. Many geriatricians do prescribe trazodone on occasion, it is considered less risky than other medications and seems to be fairly well tolerated by most people. For instance, in this study of trazodone in people with Alzheimer’s, trazodone did not appear to affect results on a short cognitive test.
That said, everyone is an individual and even when a drug seems to be “well-tolerated” by most, there is often a minority that seems particularly sensitive or experiences more side-effects than most. Sounds like you’ve learned this drug doesn’t work well for you. Good luck!