Anticholinergic side‐effects of antidepressants: Studies of the inhibition of salivation

Abstract

Studies of the peripheral anticholinergic effects of antidepressants initiated by Ole J. Rafaelsen are reviewed. They were all cross-over trials, either in patients who received continuous medication or in which continuous medication was temporarily discontinued, or in volunteers given single doses. Anticholinergic effects were evaluated from the inhibition of salivation rate measured by a tampon method. In essence, the studies revealed that 1) the method was sufficiently reliable and sensitive, 2) inhibition of salivation by tricyclic antidepressants persisted during longterm treatment, and 3) the newer antidepressants Nomifensine, Zimeldine, Mianserin, Citalopram, and Femoxetine were less potent as to anticholinergic effects than tricyclic antidepressants.The results of the studies reviewed have generally been in good agreement with similar studies of other centers and with clinical between-group studies. Other authors have found a sufficient specificity of salivation rate measurements for anticholinergic effects, but other methods, for instance based on heart rate measurements, may prove to be more specific.

Minireview on the Connections between the Neuropsychiatric and Dental Disorders: Current Perspectives and the Possible Relevance of Oxidative Stress and Other Factors

“…A correlation between high levels of prostaglandins found in salivary products and severity of depressive conditions was highlighted as an intriguing perspective considering that 3 Oxidative Medicine and Cellular Longevity Tricyclic and heterocyclic antidepressants [35] Geriatric population [36] The high incidence of certain side effects even in the placebo groups might have a connection with the neurotic symptomatology [35] Tricyclic and heterocyclic categories of antidepressants target anticholinergic activity by blocking parasympathetic salivary glands [35] The use of hyposalivatory medications increases with age [36] The anticholinergic side effects of classical tricyclic antidepressants are persistent [37] Undertreatment 15 schizophrenic patients with 1 never being admitted to the hospital or receiving neuroleptic treatment [46] Psychiatric and/or schizophrenic patients + healthy controls Lack of pain complaints suspected to be an ubiquitous dulling reply to pain connected with blunted replies that they present also to pleasure and basic emotions [41,47] Tinnitus-being mistaken as possible auditory hallucinations [46] > Altered diagnosis of the patient's mental status [46] Almost 50% of the psychiatric group presented evident abnormal attrition in contrast with 20% in the control group along with significant differences for mean muscle and joint sensitivity to palpation and the range of mouth opening [45] Hypoalgesia [57].…”

Measurement of Anticholinergic Effects of Psychotropic Drugs in Humans

“…Probably the most common method to estimate peripheral anticholinergic drug effect in a clinical setting is the measurement of either stimulated or unstimulated salivary secretion [5,18,30,38]. Saliva stimulation can easily be achieved by application of citric acid (lemon juice) onto the tongue [53] or by active chewing of paraffin [44].…”

“…Even though the salivary flow is also regulated by adrenergic receptors [19], these simple tests have proved to be sufficiently reliable for the assessment of anticholinergic influences [18,35] that are mediated principally via the muscarinic receptor subtype M 3 [8]. The measurement of salivation rate has actually been found more sensitive and specific of anticholinergic effect than, e. g. measurements of pupillary diameter, sweating or heart rate [77].…”

“…Among the antidepressive agents, the most severe anticholinergic effects (³ 60 % inhibition of salivation with the average dosage of the drug) have been measured during treatment with amitriptyline, nortriptyline, imipramine, clomipramine, dothiepin and maprotiline, and moderate (~30±60 % inhibition) with desipramine and mianserin [5,18,35]. SSRIs such as fluoxetine and citalopram have not usually expressed any marked effects on salivation [35,58].…”

Καταγραφή Της Στοματικής Κατάστασης Και Των Συνηθειών Οδοντιατρικής Φροντίδας Περιπατητικών Ηλικιωμένων Που Ζουν Στην Κοινότητα Και Συσχέτισή Της Με Ιατρικούς Και Κοινωνικοοικονομικούς Παράγοντες

“…Επιπρόσθετα, η φαρμακευτική αγωγή για την κατάθλιψη μπορεί να δημιουργήσει προβλήματα στο στοματογναθικό σύστημα. Τα τρικυκλικά αντικαταθλιπτικά έχουν έντονη αντιχολινεργική δράση με αποτέλεσμα κατά τη χρήση τους να μειώνεται έντονα η έκκριση σάλιου και να προκαλείται ξηροστομία (Friedlander and Norman 2002, Narhi et al 1992, Clemmesen 1988, Rundergren et al 1985, Papas et al 1993, Peeters et al 1998. Τα νεώτερα αντικαταθλιπτικά έχουν μικρότερου βαθμού αντιχολινεργική δράση αν και η γνώση πάνω σε αυτό είναι ακόμη περιορισμένη (Friedlander and Norman 2002, Peeters et al 1998, Velasco -Ortega et al 2013, Rafaelsen et al 1981.…”