Urinary incontinence associated with anxiety and depression: the impact of psychotropic drugs in a cross-sectional study from the Norwegian HUNT study

Abstract

Background Anxiety and depression are in both cross-sectional and longitudinal studies associated with urinary incontinence (UI) in women, strongest for the urgency component of UI. The role of psychotropic drugs in this association, especially antidepressants, has been questioned, but not clarified. The present study aimed to explore the associations between UI and anxiety/depression and the possible impact of psychotropic drugs on these associations. Methods We conducted a cross-sectional, population-based study with questionnaire data from 21,803 women ≥20 years in the Norwegian Nord-Trøndelag Health Study merged with the Norwegian Prescription Database, which contains information on all dispensed prescriptions. We used multivariate logistic regression to investigate the association between UI (any UI, and by type and severity) and anxiety/depression (by different score on Hospital anxiety and depression scale), and the influence of psychotropic drugs on this association (by different volume of drug use). Results Compared with normal anxiety- and depression score, having moderate/severe anxiety or depression (HADS≥11) increased the prevalence of UI from 27.6 to 37.8% (OR 1.59 (1.40–1.81), p < 0.001) for anxiety and from 28.0 to 43.7% (OR 1.79 (1.46–2.21), p < 0.001) for depression. According to type of UI, mixed UI was most strongly associated with a high HADS-score with an odds ratio 1.84 (1.65–2.05) for anxiety and 1.85 (1.61–2.13) for depression. Compared to no UI, severe UI was associated with depression with odds ratios of 2.04 (1.74–2.40), compared with no UI. Psychotropic drug use did not influence the associations between UI and anxiety/depression. We found high prevalence of UI among users of various psychotropic drugs. After adjustments, only antidepressants were associated with UI, with OR 1.36 (1.08–1.71) for high defined daily dose of the drug. Anxiolytics were associated with less UI with OR 0.64 (0.45–0.91) after adjustments for anxiety. Conclusion This study showed that anxiety, depression and use of antidepressants are associated factors with UI, strongest for urgency and mixed type of UI, with increasing ORs by increasing severity of the conditions and increased daily dose of the medication. Use of antidepressants did not influence the associations between UI and anxiety/depression.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients

“…In contrast, peripheral serotonin, through stimulation of bladder 5-HT 2 , 5-HT 4 , and 5-HT 7 serotonin receptors, may promote detrusor contraction and facilitate micturition [51,52]. From this perspective, the results of the present and previous studies [49,50] may reflect peripheral rather than central serotonergic control of micturition. It is possible that in some patients treated with SSRI antidepressants increased serotonin levels and stimulation of specific 5-HT receptors in the bladder enhance SUI symptoms.…”

“…In this respect, our findings tend to support previous observations on antidepressants and lower urinary tract symptoms. In a cross-sectional, population-based study based on mailed questionnaires, Felde et al [49] found that the use of antidepressants, but not anxiolytics, was associated with a general risk of urinary incontinence. A study of psychiatric patients [50] undergoing nocturnal polysomnography in a sleep center revealed that treatment with the SSRI drug, sertraline, increased nocturnal urinary frequency as compared to the serotonin-noradrenaline reuptake inhibitor (SNRI), duloxetine.…”

“…In addition, all the patients underwent a urogynecological examination which allowed us to exclude patients with other major comorbidities, such as POP ≥ II and urinary tract infection. In many previous studies on this topic, non-clinical samples were recruited and tested with postal-, telephone-, or internet-based tools [8,10,49]. In fact, in some of these studies, patients with clinically relevant psychiatric disorders were excluded by the study protocol.…”

The influence of COVID-19 restrictions on bladder and bowel symptoms: A Case Report

“…showed that anxiety and depression are associated factors with urinary incontinence and that the severity of those conditions correlated with the urinary incontinence severity [19].…”

Family Physician’s Educational Interview with Patients Helps in Early Recognition of Lower Urinary Tract Symptoms

“…2 Furthermore, LUTS should be recognized and treated as early as possible. Although symptoms manifest in the context of LUT, LUTS can be a sign of serious medical conditions with an etiology in other organic systems, [3][4][5][6][7][8][9][10] or it can serve as base for the development of other diseases, [11][12][13][14] and it significantly decreases the quality of life. [15][16][17][18] However, primary health care, and especially patients, still do not recognize LUTS early enough.…”