Antimuscarinic Use in Females With Overactive Bladder Syndrome Increases the Risk of Depressive Disorder: A 3‐Year Follow‐up Study

Abstract

To date, the relationship between antimuscarinics for overactive bladder (OAB) syndrome and depressive disorder still remains unclear. Therefore, this retrospective cohort study examined the association between antimuscarinic use and the subsequent risk of depressive disorder using a population-based data set. This study used data from the Taiwan Longitudinal Health Insurance Database 2005. We selected 1952 OAB women who received antimuscarinics as the study cohort and 9760 OAB women who did not receive antimuscarinics as the comparison cohort. Each subject was tracked for 3 years from her index date to determine all those who were subsequently diagnosed with depressive disorder. Results indicated that the adjusted hazard ratio (HR) for depressive disorder in OAB women who received antimuscarinics was 1.38 (95% confidence interval [CI], 1.15-1.64) compared with those OAB women who did not receive antimuscarinics. In addition, the adjusted HRs for subsequent depressive disorder for OAB women aged 18-39, 40-59, and ≥60 years who received antimuscarinics were 1.83 (95%CI, 1.27-2.64), 1.36 (95%CI, 1.03-1.81), and 1.16 (95%CI, 0.86-1.56), respectively, compared with those OAB women who did not receive antimuscarinics. We concluded that women with OAB who received antimuscarinics had a significantly higher risk of subsequent depressive disorder compared with those OAB women who did not receive antimuscarinics. Accordingly, clinicians should be alert to the relationship between antimuscarinics usage and depressive disorder in OAB women and provide appropriate instructions for these patients.

Are anticholinergic medications used for overactive bladder associated with new onset depression? A population‐based matched cohort study

“…We did not find that the use of OAB anticholinergic medication was associated with a significant increase in the risk of depression. This is contrary to a previously published study 5 has itself been shown to be associated with depression. 11 Urgency incontinence (usually considered a more severe manifestation of OAB) is more likely to be associated with depression, 12 and women with more severe symptoms are more likely to seek medical treatment.…”

“…We did not find that the use of OAB anticholinergic medication was associated with a significant increase in the risk of depression. This is contrary to a previously published study 5 which used administrative data claims to show that women in Taiwan who used anticholinergics for OAB had a significantly increased risk of depression (HR 2.15) compared to women with an OAB diagnosis but no anticholinergic use. A key limitation of that study is that the validity of the codes used to identify untreated OAB patients had not been measured.…”

“…While there is considerable evidence supporting this association, another aspect of central nervous system harm has been raised. A population‐based study from Taiwan demonstrated that OAB anticholinergic medications were associated with a higher risk of depression 5 . There is biologic plausibility for this relationship, as basic science studies have demonstrated links between muscarinic receptors and depression, and an imbalance in central cholinergic levels may contribute to clinical depression 6,7 .…”

Recent advances in pharmacological management of urinary incontinence

“…Little evidence is available to support the long-term use of anti-muscarinics. Besides the typical systemic effects which can include dry mouth, constipation, and blurry vision, increasing new evidence indicates that cumulative anti-muscarinic use is associated with an increase in incident dementia 18 as well as mood disorders, including depression 19 . These findings support earlier reports of associated depression with short-term anti-muscarinic treatment 20 .…”

Symptoms of overactive bladder (OAB) in patients treated for depressive disorders

“…Overactive Bladder (OAB) refers to, according to International Continence Society (ICS) defini-Archives of Psychiatry and Psychotherapy, 2020; 1: [40][41][42][43][44][45][46][47][48] tion from 2002, the occurrence of urinary urgency usually accompanied by pollakiuria (urination 8 or more times a day, or according to recent diagnostic trends such frequency, which is associated with annoyance and a decrease in quality of life) and nokturia (the complaint that the individual has to wake at night one or more times for voiding and urinating is preceded by a period of sleep, which also follows), with a possible urine incontinence [1].…”