For some time, there has been growing concern that some prescription drugs are over-prescribed and do more harm than good. Prescription drugs cause 100,000 deaths per year and are now the fourth leading cause of death in the United States (1). According to the National Institute on Drug Abuse, 50 percent of the 2.1 million drug-related emergency room visits are from prescription medications — more than from illicit drugs, alcohol, and recreational drug use combined (2). But one of the most insidious ways prescription drugs are doing harm is their effect on our short-term and long-term brain health.
You might expect that mood-altering drugs like antidepressants and anti-anxiety drugs could harm your brain. But surprisingly, many of the worst offenders are not prescribed for brain health or mood disorders. Let’s take a look at how the worst offenders are affecting our brains and the growing problem of polypharmacy — what happens when you take more than one medication at a time.
Prescription sleeping pills like Ambien, Sonata, and Lunesta are called “Z drugs” because they contain the active ingredients zolpidem, zaleplon and eszopiclone. According to Medical News Today, ever since these drugs hit the market in 2006, people have been reporting “Ambien amnesia” or “Ambien blackouts” — getting up in the night with no recollection of it the following day (3). Some users report sleepwalking, sleep eating, having sex while asleep, and even sleep driving. Others experience night terrors and hallucinations. In an interview on the TV show 20/20, Charlie Sheen openly called Ambien “the devil’s aspirin.” When Hollywood’s bad boy rejects a drug, you know there’s a problem!
Dr. Kirk Parsley is a physician, former Navy SEAL and sleep expert for the U.S. Navy. He now devotes his career to understanding sleep and teaching the importance of sleep to others. “When I first reported to the SEAL teams as their doctor, I was struck by how many SEALs were using Ambien (and other sleep drugs) on a regular basis,” he writes on his blog (4). Dr. Parsley made a startling discovery when studying people under the influence of the popular sleep drug Ambien: EEGs revealed that their brains did not show the normal patterns of the stages of sleep. Instead, their brains exhibited the same brainwave patterns one experiences in a coma or passed out from alcohol. According to Dr. Parsley, taking a sleep pill does not in fact put you to sleep, it renders you unconscious, thus bypassing the restorative value of sleep. This is disastrous for your brain since it’s during sleep that your brain consolidates the day’s memories, clears itself of metabolic debris, maintains and repairs itself, and grows new cells (5, 6, 7, 8).
Statin cholesterol-lowering medications like Lipitor and Crestor have been a pharmaceutical gold mine. They are among the most commonly prescribed drugs and also some of the most profitable. Currently, half of senior men and one-third of senior women have been put on these drugs (9). Last year, the American Heart Association released new guidelines that would double the number of people taking statins (10). And if some doctors had their way, everyone over the age of 40 would automatically be given cholesterol-lowering drugs (11). But the fight against cholesterol has been a battle waged in the wrong war. Cholesterol has been demonized as the cause of heart disease, but the theory that cholesterol causes heart disease is a mistaken one. Half of all people who have heart attacks have normal cholesterol levels (12).
Cholesterol is necessary for life. Every cell in your body needs it for healthy cell membranes. It’s essential for synthesizing neurotransmitters, sex hormones and the essential nutrients CoQ10 and vitamin D (13). And it’s critical for a healthy brain. The dry weight of the brain is one quarter cholesterol so it should come as no surprise that cholesterol-lowering drugs negatively impact it. The U.S. Food and Drug Administration (FDA) now requires statins to have a warning label stating “increased risk of liver damage, memory loss and confusion, type 2 diabetes and muscle weakness” (14). Low cholesterol has been linked to suicide, accidents, and violence in numerous studies (15, 16, 17). But one of the biggest shockers about cholesterol is that high cholesterol is associated with a significantly reduced risk of dementia (18). You read that right — by actively lowering your cholesterol, you are raising your risk of dementia!
One outspoken opponent of cholesterol-lowering medications is Dr. Duane Graveline, a physician and former NASA astronaut. He suffered from two terrifying bouts of transient global amnesia caused by the cholesterol-lowering drug Lipitor. If you currently take statins and are looking for science-based evidence on cholesterol-lowering drugs and why high cholesterol is not the heart disease risk we’ve been told, I recommend you visit Graveline’s website Spacedoc.com.
Popular prescription tranquilizers like Valium, Xanax, and Ativan fall into a class of drugs known as benzodiazepines, colloquially called “benzos” or “mother’s little helpers.” They are usually prescribed for anxiety, insomnia, and panic attacks. Side effects of these drugs include mental confusion, loss of coordination, dizziness, depression, irritability, headaches, aggression and memory loss (19). They have been controversial from the start because they are highly addictive. Benzodiazepine addicts have a higher risk of dementia. So do seniors who take these drugs. They increase their risk of developing dementia by an alarming 50 percent (20).
The usual medical treatment for depression is antidepressant medication. There are several categories of antidepressants with the most popular being the group known as selective serotonin reuptake inhibitors (SSRIs). SSRIs are usually prescribed first because they have relatively fewer side effects than other antidepressants. Yet their side effects include anxiety, panic attacks, mood and behavior changes, drowsiness, loss of sex drive, apathy, extreme agitation, aggression, restlessness, hyperactivity, impulsiveness, tremors, insomnia, and ironically, an increase in depression (21, 22).
The most frightening and unacceptable side effect of SSRIs is the possibility of suicidal thoughts. While these drugs can cause suicidal thoughts in patients of all ages, they are more likely to do so in children, teens, and young adults (23, 24). The FDA requires all antidepressants to carry a “black box warning” stating that people under age 25 may have an increase in suicidal thoughts or behaviors when taking a new antidepressant (25).
Acetylcholine is a major neurotransmitter that has a significant role in learning and memory. And a surprising number of medications work by blocking its action. These anticholinergic medications are notorious for causing side effects that resemble dementia such as mental confusion, incoherent speech, delirium, blurred vision, memory loss, and hallucinations (26). This is not a coincidence! Dementia and Alzheimer’s are associated with low acetylcholine levels and medications for these disorders work by blocking the breakdown of acetylcholine.
Remembering which drugs are anticholinergic is easy. Most drugs whose names start with “anti” affect acetylcholine levels. This includes some of the most widely prescribed drugs such as antihistamines, antidepressants, antibiotics, antipsychotics, antispasmodics, and antihypertensives (27).
It’s not only prescription drugs that work by blocking acetylcholine. Some of the most popular over-the-counter (OTC) remedies found in any drug store are anticholinergic (28, 29). This includes many brand name products for allergies, insomnia, pain, motion sickness, and acid reflux. One large study found that seniors who take these OTC medications significantly increase their risk of dementia and Alzheimer’s and that noticeable memory loss could be observed in as little as 60 days of use (30, 31). One of these drugs is the ubiquitous ingredient diphenhydramine, the generic name for Benadryl. Many OTC products for treating allergies, colds, cough, sinus problems, skin irritations, insomnia, headache, and pain contain diphenhydramine. You can find a comprehensive list of OTC medicines that contain diphenhydramine at Drugs.com.
The Growing Problem of Polypharmacy
Mayo Clinic reports that 70 percent of Americans take at least one prescription medication, 50 percent take two, and 20 percent take five or more (32). According to the American Society of Consultant Pharmacists, the average senior takes 14 medications each year and adverse drug reactions are responsible for 28 percent of hospitalizations of the elderly (33). When one drug is taken, there’s a risk of side effects, but when more than one drug is taken at a time, that risk grows exponentially. This problem is called polypharmacy — the taking of several drugs at once that interact in negative and sometimes unexpected ways. Polypharmacy is often a result of the vicious cycle of drugs being prescribed to help with the side effects of other drugs. Polypharmacy becomes a greater concern with age. Not only are seniors more likely to take multiple medications, but their livers and kidneys have become less efficient at breaking down and eliminating drugs from their system.
Armon Neel, Jr, PharmD, CGP is a fifth generation pharmacist who writes about safe medication use for AARP’s “Ask the Pharmacist” column. He is an expert in geriatric pharmacology who believes there is an epidemic of overmedication. In his eye-opening book, Are Your Prescriptions Killing You?, he makes the horrifying indictment that as many as 3 out of 4 Alzheimer’s cases are caused by drug interactions.
What You Can Do
We’ve covered only a handful of medications that impact your brain. There are many others. If you take any prescription medications you feel are affecting your mood, memory, or cognitive skills, follow the advice of Armon Neel. He recommends having heart-to-heart conversations with both your physician and your pharmacist about the medications you’re taking. Do your homework and go in armed with information on natural approaches that can mitigate your use of medications such as improving your diet, nutritional supplements, herbal remedies, exercise, or relaxation techniques. Work with your doctor to create a plan for minimizing offending medications. If your doctor is not on board with this idea, Neel recommends enlisting the aid of a consultant pharmacist who specializes in helping patients intelligently manage their prescriptions.