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A panel of psychiatric experts, including Dr. Jonathan Meyer and Dr. Leslie Citrome, provides critical insights into anticholinergic medications, their appropriate uses in psychiatry, and important considerations for deprescribing. The discussion focuses on mechanisms of action, common misuse patterns, and the significant impact of anticholinergic burden on patient outcomes.
Key Points:
- Anticholinergic medications primarily serve to mitigate drug-induced movement disorders like parkinsonism and acute dystonia in psychiatric practice. However, evidence shows these medications are ineffective for treating akathisia and can worsen tardive dyskinesia, highlighting the importance of appropriate prescription practices.
- The medications work by blocking muscarinic and cholinergic receptors, affecting both nicotinic receptors (involved in fast neurotransmission) and G-protein-coupled receptors. Their therapeutic effect in treating drug-induced parkinsonism stems from restoring cholinergic-dopaminergic balance in the striatum.
- Peripheral side effects include dry mouth, constipation, blurred vision, tachycardia, and potential urinary retention in males. The medications can also impair cholinergic-mediated sweating, creating additional risk factors for patients.
- Central effects present a significant clinical concern, particularly cognitive impairment. This becomes especially problematic when treating patients who already have baseline cognitive deficits.
- Common misuse patterns include extended prophylactic use of benztropine for drug-induced parkinsonism and inappropriate application for conditions where these medications show no efficacy.
“Unfortunately, exposure to centrally acting anticholinergic agents will impair cognition. It’s actually used as a model for this when we’re looking at cognitive abilities.”
– Dr. Leslie Citrome, Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College
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