Do you have difficulty remembering things? It could be a side effect of one of your medications.
For a long time, doctors dismissed forgetfulness and mental confusion as a normal part of aging. But scientists now know that memory loss as you age is by no means something that can’t be avoided. In reality, the brain can generate new neurons and reconfigure its connections throughout life.
Anxiolytics (Benzodiazepines)
Why they are prescribed: Benzodiazepines are used to treat a variety of anxiety disorders, agitation, delirium, and muscle spasms, and to prevent seizures. Because benzodiazepines have a sedative effect, they are sometimes used to treat insomnia and anxiety that can accompany depression.
Examples: Alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed) , quazepam (Doral), temazepam (Restoril), and triazolam (Halcion).
Why they may cause memory loss: Benzodiazepines decrease activity in key parts of the brain, such as those involved in transferring events from short-term memory to long-term memory.
Indeed, benzodiazepines are used in anesthesia for this very reason. When added to the anesthesiologist’s drug cocktail, patients rarely remember any unpleasant sensations from the procedure. Midazolam (Versed) especially has marked amnesiac properties.
Alternatives: My opinion is that benzodiazepines should be prescribed only rarely to older people and only for short periods. Because it takes older people much longer than younger people to eliminate these drugs from the body, the resulting accumulation puts them at greater risk of memory loss, as well as delirium, falls, fractures, and car accidents.
If you take any of these drugs for insomnia, mild anxiety, or agitation, talk to a doctor or other health care professional about treating your condition with other types of medications or without drugs. If you have insomnia, for example, melatonin might help. Taken before bed in doses of 3 to 10 mg, melatonin can help restore healthy sleep patterns.
Be sure to consult with a healthcare professional before stopping or reducing the dose of any benzodiazepine. Stopping taking this drug suddenly can cause serious side effects, so a health professional should always monitor the process.
Cholesterol-lowering medications (statins)
Why they are prescribed: Statins are used in the treatment of high cholesterol.
Examples: Atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor).
Why they can cause memory loss: Drugs that lower blood cholesterol levels can affect memory and other mental processes by lowering cholesterol levels in the brain.
In the brain, these lipids are essential for the formation of connections between neurons; the links that underlie memory and learning. (The brain, in fact, contains a quarter of the cholesterol of the entire body.)
According to a study published in the journal Pharmacotherapy in 2009, three out of four people taking these drugs suffered adverse cognitive effects, “probably or certainly related to” the drug.
The researchers further noted that 90% of patients who stopped statin therapy reported improvements in cognition, sometimes within days. In February 2012, the Food and Drug Administration ordered drug companies to add a new warning label about possible memory disorders to the drug information for statins.
Alternatives: If you are one of the many older Americans who have not been diagnosed with coronary heart disease but are taking these drugs to treat their slightly elevated LDL (“bad”) cholesterol or low HDL (“good”) cholesterol , consult your doctor or other health care provider about replacing it with a combination of sublingual (tablet placed under the tongue) vitamin B12 (1,000 mcg daily), folic acid (800 mcg daily), and vitamin B6 ( 200 mg daily).
Anticonvulsants
Why they are prescribed: Anticonvulsants, which have long been used to treat seizures, are increasingly used to treat neuropathic pain, bipolar disorders, mood disorders, and mania.
Examples: Acetazolamide (Diamox), carbamazepine (Tegretol), ezogabine (Potiga), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax ), valproic acid (Depakote) and zonisamide (Zonegran).
Why they may cause memory loss: Anticonvulsants are thought to limit seizures by blocking the flow of signals from the central nervous system. And, all central nervous system depressants, such as anticonvulsants, can cause memory loss.
Alternatives: Many patients with seizures benefit from taking phenytoin (Dilantin), which has little or no impact on memory. Many patients with chronic neuropathic pain find that venlafaxine (Effexor)—which also does not affect memory—relieves their pain.
Antidepressants (tricyclic antidepressants)
Why they are prescribed: Tricyclic antidepressants are prescribed for depression and, increasingly, for anxiety disorders, eating disorders, obsessive-compulsive disorder, chronic pain, smoking cessation, and to treat some hormonal disorders, such as severe dysmenorrhea. and hot flashes.
Examples: Amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil).
Why they may cause memory loss: 35% of adults taking tricyclic antidepressants report some degree of memory dysfunction, and 54% report difficulty concentrating. These antidepressants are thought to cause memory problems by blocking the action of serotonin and norepinephrine, two of the brain’s key chemical messengers.
Alternatives: Talk to your healthcare provider about whether non-drug therapies may work as well or better than a drug for you.
You could also consider lowering your dose (the side effects of antidepressants are often dose-related) or switching to a selective serotonin/norepinephrine reuptake inhibitor (SSRI/SNRI). Of the drugs in this category, I consider venlafaxine (Effexor) to have the fewest adverse side effects in older patients.
Narcotic pain relievers
Why they are prescribed: Also called opioid pain relievers, these medications are used to relieve moderate to severe chronic pain, such as pain caused by rheumatoid arthritis.
Examples: Fentanyl (Duragesic), hydrocodone (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), morphine (Astramorph, Avinza), and oxycodone (OxyContin, Percocet). These drugs come in various formats, such as tablets, injectable solutions, transcutaneous patches, and suppositories.
Why they can cause memory loss: These drugs inhibit the signals that transmit the sensation of pain within the central nervous system, and dull the emotional reaction to pain itself. Both actions are mediated by chemical messengers that are also involved in various aspects of cognition. Therefore, the use of these drugs can interfere with long- and short-term memory, especially if used for long periods of time.
Alternatives: In patients under 50 years of age, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is the first-line therapy for pain. Unfortunately, this therapy is less appropriate for older patients who face a high risk of dangerous gastrointestinal bleeding. According to research data, the risk increases with the dose and duration of treatment.
Talk to your doctor or other health care provider about whether tramadol (Ultram), a non-narcotic pain reliever, may be an appropriate option for you. I often recommend my patients supplement each 50 mg dose with a 325 mg tablet of acetaminophen (Tylenol).
Although they are prescription drugs that combine tramadol and acetaminophen, these products contain only 37.5 mg of tramadol, and in my experience, patients generally require a higher dose.
Drugs to treat Parkinson’s disease (Dopamine agonists)
Why they are prescribed: These drugs are used to treat Parkinson’s disease, some pituitary tumors, and, increasingly, restless legs syndrome (RLS).
Examples: Apomorphine (Apokyn), pramipexole (Mirapex), and ropinirole (Requip).
Why they can cause memory loss: These medications activate dopamine signaling pathways, which acts as a chemical messenger in various brain functions, such as motivation, the experience of pleasure, fine motor control, learning, and memory. . Consequently, major side effects may include memory loss, confusion, delusions, hallucinations, drowsiness, and compulsive behaviors such as overeating or gambling.
Alternatives: If you are being treated for RLS, talk to your doctor or pharmacist about whether any of the prescription or over-the-counter medications you are taking may be causing your memory loss.
Potential culprits include many anti-nausea and anti-seizure drugs, antipsychotic medications with tranquilizing effects, some antidepressants, and some anti-cold and allergy medications. In this case, RLS and memory problems could be resolved simply by replacing the medication in question with another drug.
Antihypertensives (beta blockers)
Why they are prescribed: Beta blockers slow the heart rate and lower blood pressure, and are often prescribed for high blood pressure, congestive heart failure, and arrhythmia. They are also used to treat chest pain (angina), migraines, tremors, and, in the form of eye drops, certain types of glaucoma.
Examples: Atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic), and other drugs whose chemical names end in “-olol.”
Why they may cause memory loss: Beta blockers are thought to cause memory problems by interfering with (or “blocking”) the action of key brain chemical messengers, including norepinephrine and epinephrine.
Alternatives: For older people, benzodiazepine calcium channel blockers, another type of antihypertensive medication, are generally safer and more effective than beta blockers. If the beta blocker is being used to treat glaucoma, I recommend that you talk to your health care professional about taking a carbonic anhydrase inhibitor such as dorzolamide (Tursopt) instead.
Sleeping pills (non-benzodiazepine sedative-hypnotics)
Why they are prescribed: Sometimes called “Z” drugs, these medications are also used to treat insomnia and other sleep disorders. They are also prescribed to combat mild anxiety.
Examples: Eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).
Why they can cause memory loss: Although they are molecularly different from benzodiazepines (mentioned above in item #1 on the list), they act on many of the same pathways and chemical messengers in the brain, and produce the same side effects and addiction and withdrawal problems.
“Z” drugs can also cause amnesia and sometimes lead to dangerous or strange behavior, such as cooking or driving a car, without remembering it once awake.
Alternatives: There are alternative drugs and non-drug treatments for insomnia and anxiety, so we recommend talking to your health care professional about the available options. Melatonin, in doses of 3 to 10 mg before bed, for example, sometimes helps restore healthy sleep patterns.
Be sure to consult with your health care professional before stopping or reducing the dosage of any sleep aid. Stopping taking this drug suddenly can cause serious side effects, so a health professional should always monitor the process.