Banciao, Taiwan—Antimuscarinics are used to depress bladder contractions and improve overactive bladder (OAB) symptoms by blocking muscarinic receptors. A question being raised more frequently, however, is the tolerability of side effects.

A recent study published in The Journal of Clinical Pharmacology reports that women diagnosed with OAB and treated with antimuscarinics had a 38% greater risk of depressive disorder over the next 3 years compared with a group not receiving the drugs.

“This population-based retrospective cohort study found that use of antimuscarinics was associated with subsequent depressive disorder in women with overactive bladder,” explains senior author Li-Ting Kao, MS, of Far Eastern Memorial Hospital in Banciao, Taiwan.

For the retrospective cohort study, researchers used data from the Taiwan Longitudinal Health Insurance Database 2005, selecting 1,952 women with OAB symptoms who received antimuscarinics as the study cohort and comparing them to 9,760 women with the same diagnosis who did not receive antimuscarinics.

After tracking participants for 3 years, results indicate the adjusted hazard ratio (HR) for depressive disorder in women treated with antimuscarinics for OAB was 1.38 compared with the other group.

Depressive disorder appeared to have a stronger link to use of the drugs in the younger age group, 18 to 39, with an HR of 1.83, compared with the group not taking antimuscarinics. As for other age groups on antimuscarinics, those aged 40 to 59 had an HR of 1.36, and the oldest group, aged 60 and older, had an HR of 1.16, according to the report.

“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,” the study authors caution. “Accordingly, clinicians should be alert to the relationship between antimuscarinics usage and depressive disorder in OAB women and provide appropriate instructions for these patients.”

Interestingly, another recent study, appearing in BMC Medicine, suggests the drugs don’t work well for incontinence. Swedish researchers from the Sahgrenska Academy and the Gothenburg Continence Research Center (GCRC) determined in a meta-analysis that both surgery and pelvic-floor exercises work better than drug treatment, which is effective only 49% of the time.

Surgery was the most successful treatment, managing or resolving the issue in 82% of cases. Pelvic-floor exercises came in second at 53%, and drug therapy, usually antimuscarinics, was found to be helpful in only 49% of patients.
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