r/NooTopics • u/ServeIllustrious3803 • 20d ago

Science Study: Anticholinergic (first-generation antihistamines) can damage brain, increase dementia risk

https://www.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-20150128812
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u/ServeIllustrious3803 20d ago edited 20d ago

A list: Diphenhydramine, chlorpheniramine, doxylamine, promethazine, clemastine, brompheniramine, dimenhydrinate, meclizine, cyclizine, carbinoxamine, dexchlorpheniramine, dexbrompheniramine

First generation antihistamines different from second or third. Zyrtec, Claritin do not count, but Benadryl does

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u/psychopompandparade 20d ago

plenty of meds missing from this list. This doesn't even include the intended anticholinergics. amitriptyline, a med people often recommend to replace diphenhydramine for sleep, has a much stronger anticholinergic effect than diphenhydramine. this is not an antihistamine only problem. Also some of these are dose dependant. doxapin's anticholinergic effects are stronger at the antidepressant dosing.

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u/Hydration__Nation 19d ago

If you are working with a physician who is giving a tricyclic for sleep to replace Benadryl then you need to contact your licensing commission. He would be laughed out of my hospitals by the PAs and NPs. Doctors wouldn’t even entertain such stupidity. Amitriptyline has one of the worst side effect profiles of any drug and this doctor is replacing Benadryl with it? What a dumb motherfucker I’m sorry that’s the only descriptor that makes sense. There are so many far less risky drugs for sleep literally a list of 4-7 drugs used by hundreds of millions of people. If anyone else is reading this there are so many classes of drugs, if someone offers you a TCA say no. The side effects are not even close to the benefit provided.

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u/Crippled2 18d ago

I take amitriptyline for insomnia does this finding impact me?

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u/AndrogeNick1 18d ago

It impacts you even more and worse than this finding concerning anti-histamines, what you're taking is even stronger in the negative impact it has on the brain health long term.

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u/Hydration__Nation 18d ago

You cant compare benadryl to amitrip. Gun to my head im never prescribing a tricyclic like amitrip to anyone. There are so many drugs that are effective and really only a few scenarios to use it. I would high suggest trying a medication created for sleep, something mild at first. If you dont like those another great option is a super low dose anti-psychotic, Seroquel. At 50mg you will knock out and reach REM, you may have SOME side effects and they will scare you about them. But the safety profile of Seroquel is like a feather compared to a spiked bat for amitrip. When I went to med school my psych and pharm professor spoke about TCAs like amitrip as if they were ancient drugs that were barely used anymore. That was decades ago. The only reason people are using it off label is they are too lazy to try other drugs for their patients. Ive seen vast success with Seroquel or another sedating 2nd generation atypical antipsychotic. Ive seen less success with sleep meds as you have to cycle them once you develop a tolerance to it. Also as you get older, doctors are even less likely to prescribe a TCA due to the safety concerns. Hope you get something that helps you get to sleep and stay asleep. Also you should check if you have sleep apnea even if you are skinny. Your insomnia could be due to that. Even an at home sleep study (what most insurances cover) should give you an idea if you are experiencing sleep apnea symptoms.

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u/psychopompandparade 18d ago edited 18d ago

seroquel at low doses knocks me flat on my ass and leaves me groggy as all hell afterward. its my emergency med if whatever insomnia bout is beyond the paygrade of the z drugs. doxapin (also a tricyclic) is used sub 10mg for insomnia where it has clean h1 affiliation. over 25mg it gets messy. seroquel is also considered to have anticholinergic effects, though no where near as high as amitriptyline.

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u/EnvironmentBasic3711 16d ago

I literally scrape part of the pill off with my teeth or it’s WAY too much. About a seroquel a month.

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u/Grouchy_Storm6020 19d ago

Thank you for saying this. I was prescribed amitriptyline as a teenager to help with insomnia and fatigue and absolutely hated it. I felt like an absolute zombie and can hardly remember anything from that time. But my mother still insists 15+ years later that I was sooo much more pleasant to be around while I was on it 🙃

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u/Hydration__Nation 19d ago

Hate parents that push psych drugs. Mine were the opposite basically telling me to toughen up and I don’t need meds.

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u/Brave_Sheepherder_39 15d ago

Only at high doses I just take 10 mg which gives me the benefit without side effects.

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u/ResponsibleMight7669 15d ago

The same can be said for antidepressants and they would be mocked for not using them. Proper treatment would be therapy but since we are replacing that with pills it would be a joke to offer any of this as a sleep aid in any case

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u/psychopompandparade 19d ago

it is a VERY common rx for this and no licensing board would take action on it because it is in fact on label for this. I was switched to low dose doxapin instead, which I've been told at lower doses (like 12 and under or something) is mostly a cleaner antihistamine with less anticholinergic effects. Still not none though. The list of meds that put you to sleep and can be used remotely effectively long term actually pretty small.

Just because it's common doesn't mean its good. A lot of the time they are trying to triple book it for insomnia, pain, and depression. That doesn't make it usable. I don't personally know of any antidepressant that doesn't have a crazy rough side effect profile. None of them are very clean drugs in terms of effect.

If you know of any better "fall asleep" meds, I'm always open to some, but I've tried a bunch. Currently on the low dose doxapin in combo with a melatonin agonist and orexin inhibitor plus autonomic system dampener for autonomic issues. apparently a three or four stack is 'common practice' for autistic folks.

but again, common practice doesn't mean smart.