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Anticholinergic side-effects of antidepressants: studies of the inhibition of salivation
1Department of Psychiatry, Frederiksberg General Hospital, Hillerød, Denmark.
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 long-term 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.
Insights
This review highlights that measuring salivation rate is a reliable method to assess anticholinergic effects of antidepressants. Newer antidepressants show fewer anticholinergic side effects compared to older tricyclic antidepressants.
Area of Science:
- Pharmacology
- Clinical Neuroscience
- Psychopharmacology
Background:
- Anticholinergic effects are common side effects of many antidepressant medications.
- Understanding these effects is crucial for patient safety and treatment adherence.
- Ole J. Rafaelsen's research focused on quantifying peripheral anticholinergic activity.
Purpose of the Study:
- To review studies on the peripheral anticholinergic effects of antidepressants.
- To evaluate the reliability and sensitivity of salivation rate inhibition as a measurement method.
- To compare the anticholinergic potency of tricyclic antidepressants with newer agents.
Main Methods:
- Cross-over trials involving patients and healthy volunteers.
- Measurement of salivation rate inhibition using a tampon method.
- Evaluation of both continuous and single-dose administration of antidepressants.
Main Results:
- The salivation rate inhibition method is reliable and sensitive for detecting anticholinergic effects.
- Anticholinergic effects of tricyclic antidepressants are sustained with long-term treatment.
- Newer antidepressants (Nomifensine, Zimeldine, Mianserin, Citalopram, Femoxetine) exhibit lower anticholinergic potency than tricyclics.
Conclusions:
- Salivation rate measurement is a valid method for assessing anticholinergic properties of antidepressants.
- Tricyclic antidepressants have persistent anticholinergic effects.
- Newer antidepressant medications offer a potentially improved side effect profile regarding anticholinergic activity.