There is no prospective study to see whether antidepressants would ameliorate both depression/anxiety and OAB. It is reported that duloxetine (an SNRI) benefited women with stress urinary incontinence. Also, well-known adverse events by SSRI and SNRI include urinary retention. In contrast, venlafaxine (an SNRI) increased micturition frequency and lessened post-void residual volume. In a larger study among women with self-reported
depression, the use of serotonergic antidepressants was statistically associated with urinary incontinence, although it is unclear whether this was secondary to larger post-void residuals. In a study by Ito et al. previous antidepressant treatment did not significantly affect click here the frequency of urinary urgency or delayed start between the drug-naïve group and the medicated group, who were taking tricyclic Selleck AZD1152-HQPA antidepressants, tetracyclic antidepressants, SSRIs, SNRIs and others. A recent study
by Sakakibara et al. showed that SNRIs, but not SSRIs, ameliorated OAB of various etiologies. Taken together, when we first see patients with both depression/anxiety and OAB, prescribing an SNRI (or other antidepressants and benzodiazepines) might be a good choice. If the first line treatment for depression/anxiety (serotonergic and other drugs) fails to ameliorate OAB, addition of anticholinergic drugs such as oxybutynin, propiverine, tolterodine, solifenacin, and imidafenacin is
an option, although no systematic data on the use of anticholinergics for OAB in depression/anxiety are available. In elderly patients with depression/anxiety, the use of medications with anticholinergic side-effects is of concern, particularly when there is a risk of exacerbating cognitive impairment. Crossing the blood–brain barrier (BBB), they can act at the M1-muscarinic receptors in the cerebral cortex and hippocampus, or M4-receptors in Calpain the basal ganglia. Factors predisposing patients to cognitive side-effects include (i) central muscarinic receptor affinity, e.g. high M1-receptor selectivity; and (ii) permeability across the BBB: size, lipid solubility, fewer hydrogen bonds, neutral or low degree of ionization and a small number of rotatable bonds.[69, 70] Darifenacin is an M3-selective antagonist and thus has less marked cognitive side-effects while trospium, a quaternary amine, has high polarity and therefore poor permeability across the BBB. Other anticholinergic side-effects include dryness of the mouth (M3) and constipation (M2,3), the latter being common in serotonergic drug use. Extended-release formulations may lessen these adverse effects. Mirabeglon, a novel adrenergic beta-3 receptor agonist, seems to be promising for lessening DO with fewer central side-effects.