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. Among other reasons, we do find that in some people, certain medications are causing memory loss symptoms — or other cognitive symptoms — to be worse.
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
You can also watch a subtitled video version of this information below.
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 older adults 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 aging adults:
- 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 aging adults:
- These drugs worsen balance and increase fall risk.
3. Anticholinergics. This group covers most over-the-counter sleeping aids, antihistamines such as Benadryl, 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.
You may have heard that “Benadryl has long-term side effects on the brain.” That’s because diphenhydramine (brand name Benadryl) is strongly anticholinergic.
A 2015 study found that greater use of anticholinergic drugs was linked to a higher chance of developing Alzheimer’s, and a 2021 Cochrane review found that these drugs may increase the risk of cognitive decline or dementia.
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. Or, you can look up any of your medications using this handy “anticholinergic burden scale” calculator.
I reviewed the most commonly used of these drugs in this video:
I also cover them in an article here: “7 Common Brain-Slowing Anticholinergic Drugs Older Adults Should Use With Caution.” 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 check your medications with this handy “anticholinergic burden scale” calculator.
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 aging adults, 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. 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 an 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
Opioid pain medications. Unlike the other drugs mentioned above, opioids (other than tramadol and meperidine) 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, opioids 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; these are commonly used cholesterol-lowering medications, such as simvastatin and atorvastatin (brand names Zocor and Lipitor, respectively).
But this concern seems to be unfounded: 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.
Personally, I do not worry about the cognitive effect of statins; I feel my patients are much more likely to be harmed by regularly using something like Benadryl, which is anticholinergic.
For a comprehensive list of medications identified as risky by the experts at the American Geriatrics Society, be sure to review the most recent 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.
I explain how to find a geriatric doctor near you here: How to find a geriatrician — or a medication review — near you.
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!
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.
Sherri says
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?
Leslie Kernisan, MD MPH says
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.
Bob Varisco says
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
Leslie Kernisan, MD MPH says
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.
Heather says
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.
Leslie Kernisan, MD MPH says
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.
Stung47000 says
Agree with you Doc. Bob V was quite disrespectful there.
Thank you for your thoughtful, educated and FREE advice.
Tina says
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 ?
Leslie Kernisan, MD MPH says
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.
Hugh McIsaac says
Nice answer!!! Very thoughtful and nuanced.
Kim says
Does wellbutrine effect memory ? Are there mood stabilizers that don’t effect your memory
Leslie Kernisan, MD MPH says
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.
Grace Smith says
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.
Leslie Kernisan, MD MPH says
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.
Julie D Phillips says
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.
John Sullivan says
Great article Dr. Kernisan. I appreciate the information that you share. I posted a link on our website.
Leslie Kernisan, MD MPH says
Thank you, glad you find the article helpful.
Sue says
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
Leslie Kernisan, MD MPH says
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!
David Nelson says
Dr. Do you know any drugs besides adderall that increases brain function?
Iam on alot.
Leslie Kernisan, MD MPH says
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.
Sue says
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!
Leslie Kernisan, MD MPH says
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!
Cecile Kiley says
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.
Leslie Kernisan, MD MPH says
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.
Jennifer Roa says
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).
Leslie Kernisan, MD MPH says
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.
samuel says
What about the cough syrups? What effects do they have in terms of slowing down brain function?
Leslie Kernisan, MD MPH says
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.
Jim Schreiber says
Doctor,
Great article! Your insights are extremely valuable and are greatly appreciated. Thank you.
Leslie Kernisan, MD MPH says
Thank you, glad you found this helpful.
Lewis says
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
Leslie Kernisan, MD MPH says
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
KV says
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?
Leslie Kernisan, MD MPH says
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!
Jack Garrett says
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.
Leslie Kernisan, MD MPH says
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.
Tom Boddington says
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.
Shirley Kulesza says
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.
Leslie Kernisan, MD MPH says
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.
Scott Buley says
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?
Leslie Kernisan, MD MPH says
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
Heath says
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?
Leslie Kernisan, MD MPH says
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!
Andrea Thorn says
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
Leslie Kernisan, MD MPH says
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!
Jack Garrett says
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.
Leslie Kernisan, MD MPH says
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!
Ashley says
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
Teri Lee says
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.
Leslie Kernisan, MD MPH says
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.
Teri Lee says
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?
Leslie Kernisan, MD MPH says
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.
Chase says
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
Leslie Kernisan, MD MPH says
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.
Kulbir Singh says
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
Leslie Kernisan, MD MPH says
Glad you found this helpful.
elizabeth lucas says
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
Leslie Kernisan, MD MPH says
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.
frances says
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?
Leslie Kernisan, MD MPH says
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!
Judy says
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?
Leslie Kernisan, MD MPH says
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.