According to the results of a new retrospective cohort study published in The Journal of Clinical Pharmacology, women who use antimuscarinics to treat overactive bladder (OAB) syndrome may be at an increased risk for depressive disorder.

Researchers from Taipei Medical University, Taiwan, assessed data that included 1,952 women diagnosed with OAB who had no previous depression diagnosis and were prescribed an antimuscarinic, including oxybutynin, tolterodine, solifenacin, trospium, and propiverine. This group was compared to a control group of 9,760 women who were diagnosed with OAB but who were not prescribed any antimuscarinic treatments. The data was collected from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005).

Each patient was tracked for three years and depression cases were based on ICD-9-CM codes 296.2 (major depressive disorder, single episode), 296.3 (major depressive disorder, recurrent episode), 300.4 (neurotic depression), and 311 (depressive disorder, not elsewhere classified).  

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Results showed that incidence rates of depressive disorder per 100 person-years within the 3-year follow-up period were 2.77 (95%CI, 2.35–3.23) and 2.02 (95%CI, 1.86–2.20) for women with OAB who received antimuscarinics and those who did not receive the drugs, respectively. After adjusting for monthly income, geographical location, urbanization level, and comorbidities, the hazard ratio for depressive disorder was 1.38 (CI 95%, 1.15–1.64) in OAB women who received antimuscarinics versus those who did not. Moreover, the adjusted hazard ratios for subsequent depressive disorder for OAB women who received antimuscarinics were 1.83 (95%CI, 1.27–2.64) for women aged 18–39, 1.36 (95%CI, 1.03–1.81) for women aged 40–59, and 1.16 (95%CI, 0.86–1.56) for women ≥60 years, compared with those women who did not receive antimuscarinics.

The researchers hypothesized that some antimuscarinics with “high lipophilicity, neutral polarity, or low molecular size still cross the blood–brain barrier and further affect neurotransmission in the brain,” which could possibly trigger the depressive symptoms.

In conclusion the authors suggest that physicians be alert to the relationship between antimuscarinics and depressive disorders although they acknowledge that further studies are needed to identify the potential mechanisms involved in the relationship.

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