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New research into the long-term side effects of common drugs revealed a raised risk of cognitive impairment and increased mortality.
Prof David Nutt, President of the British Neuroscience Association and Vice-President of the European Brain Council, said:
“The negative effects of anticholinergic drugs on brain and cardiac function have been known for decades and this study reinforces their dangers. The wide use of amitriptyline and related tricyclic antidepressant drugs in primary care for depression, and also unproven indications such as insomnia, is therefore a significant concern. For these reasons most experts have recommended that antidepressants such as amitriptyline should be replaced by the SSRIs which are much safer [see attached editorial].”
Dr Tim Chico, Clinician Scientist and Honorary Consultant Cardiologist, University of Sheffield, said:
“All drugs have possible side effects, but the results of this study should not lead anyone to stop current medications without discussing this with their doctor first. Before starting any drug, it is important for the doctor and patient to discuss the possible benefits of the treatment, compared with the potential downsides, so that the patient can make an informed decision. As a cardiologist, many of the drugs I use (such as beta-blockers) have been definitely proven to make people with heart disease live longer, so it’s important to balance these proven benefits against the risk of side effects.”
Rebecca Wood, Chief Executive of Alzheimer’s Research UK, said:
“This comprehensive study could have some far-reaching effects. The results underline the critical importance of calculated drug prescription. Further investigation needs to establish exactly how and why drugs with an anticholinergic effect are increasing mortality, which might offer clues to influence safer drug design. It’s important for people prescribed medicines with an anticholinergic effect not to panic, but to discuss with their doctor the best possible personal treatment plan.
“Large cohort research is essential to understanding what might influence the prevalence of dementia in a population. These broad studies can be invaluable in shaping public health policy, yet funding for such research remains shamefully low. With the 820,000 people currently living with dementia set to increase drastically, research is the only answer and we must invest more now.”
Commenting for Alzheimer’s Research UK, Prof Simon Lovestone, Director of Research for King’s Health Partners, said:
“Older people are prescribed many drugs, as this study shows. Yet again some of these drugs have been shown to have adverse effects, including an association with cognitive decline. This is an important and very large study and although we cannot assume that the drugs are actually causing the increased decline, there is good reason to think they may be. This study has important clinical lessons for all doctors looking after older people.”
Anticholinergic medication use and cognitive impairment in the older population: The Medical Research Council Cognitive Function and Ageing Study (CFAS) by C. Fox et al., published online by the Journal of the American Geriatrics Society on June 24 2011.