Urinary side effects of psychotropic drugs: A systematic review and metanalysis

Abstract

Objective: To evaluate the effects of psychotropic drugs on bladder function. Materials and Methods: A systematic review was carried out by searching PubMed and Embase databases for randomized controlled trials enrolling patients treated with psychotropic drugs with available information on treatment-related urinary disorders.Results: A total of 52 studies was selected. In antidepressant therapy, bladder voiding symptoms, rather than storage symptoms, were more frequently observed.Pooled analysis demonstrated a higher odds ratio (OR) of voiding disorders in comparison with placebo (OR: 3.30; confidence interval [CI]: 1.90-5.72; 7856 participants; p < 0.001). Odds for voiding dysfunction was higher for tricyclic antidepressants and for Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) when compared to Selective Serotonin Reuptake Inhibitors (SSRIs). Treatment with antipsychotics was associated with heterogeneous urinary disorders including emptying and storage disorders. OR for incontinence in patients with dementia taking antipsychotics was higher than placebo (OR: 4.09; CI: 1.71-9.79, p = 0.002) with no difference between different atypical antipsychotics. Rate of voiding disorders was not different between conventional and atypical antipsychotics (OR: 1.64; CI: 0.79-3.39, p = 0.19), although quetiapine showed higher odds to cause voiding dysfunction than other atypical antipsychotics (OR: 2.14; CI: 1.41-3.26; p > 0.001). Conclusions: In patients taking tricyclic antidepressants or SNRIs, bladder voiding disorders, could be the side effects of therapy rather than symptoms of a urological disease. Patients treated with these drugs should be actively monitored for the appearance of urinary symptoms. Antipsychotic treatment is associated with various urinary side effects requiring a tailored approach.

Severe Urinary Retention Associated With Combined Treatment With Escitalopram and Quetiapine

“…The ultimate effect of each individual antipsychotic drug relies on the blend of central serotonergic and dopaminergic effects with peripheral α 1 -adrenergic and anticholinergic activity. 2 Because each drug's affinity for different receptor types varies, generalizing results, even within the same antipsychotic class, is challenging. Because of this action mechanism complexity, it is challenging to provide a generalized explanation of how antipsychotics induce urinary dysfunction.…”

“…1 Medications, like psychotropic drugs such as conventional antipsychotics with strong anticholinergic effects, some atypical antipsychotics like clozapine, and tricyclic antidepressants, are also known contributors. 2,3 This adverse effect is more prevalent in elderly patients due to comorbidities and polypharmacy. 4 However, UR associated with selective serotonin reuptake inhibitors (SSRIs) and atypical antipsychotics at low or standard doses is relatively rare in young individuals with no urological history.…”

Identification of brain functional connectivity during acute transcutaneous tibial nerve stimulation: A 3T fMRI study

“…The clinical application of TNS is potentially limited in patients with alterations of the central nervous pathways including spinal cord, brainstem, and cortical areas due to the demonstrated central nervous interaction. The alertness of the central nervous system might be influenced by specific medications (e.g., antidepressant or other medications with proven central nervous side effects) and thus might influence the processing of afferent and efferent neuronal inputs (e.g., urge to void, voiding, electrical neuromodulation) 14,15 . This shall be addressed and considered in the design of future research.…”

“…The alertness of the central nervous system might be influenced by specific medications (e.g., antidepressant or other medications with proven central nervous side effects) and thus might influence the processing of afferent and efferent neuronal inputs (e.g., urge to void, voiding, electrical neuromodulation). 14,15 This shall be addressed and considered in the design of future research.…”

Urinary tract infections in palliative care

“…urinary retention -UR) przy stosowaniu leków o działaniu antycholinergicznym (np. leków przeciwpsychotycznych, leków przeciwdepresyjnych), opioidów i środków znieczulających, agonistów receptorów α-adrenergicznych, benzodiazepin, niesteroidowych leków przeciwzapalnych (NLPZ), środków zwiotczających (w tym leków rozkurczowych) i antagonistów kanału wapniowego [34][35][36][37][38][39][40]. Z badań obserwacyjnych wynika, że mogą one odpowiadać za około 10% przypadków zatrzymania moczu [39].…”