Harvard Women's Health Watch

Ask the doctor: Which antidepressants have anticholinergic effects?

Q. An article in your April issue, "Common drugs linked to dementia," states that anticholinergics are used to treat depression. I wasn't aware of this. Which types of anticholinergics are used for depression?

A. We should have been clearer in our description of the medications. Anticholinergic drugs work by blocking the effects of acetylcholine, a substance that transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. A wide range of drugs—including tricyclic antidepressants like amitriptyline (Elavil) or doxepin (Deptran, Silenor, Sinequan)—have strong anticholinergic effects, which means they can have side effects like memory problems and confusion. These effects are more pronounced in older people, so these antidepressants are reserved for younger people. The selective serotonin reuptake inhibitors (SSRIs), like citalopram (Celexa) and duloxetine (Cymbalta), are commonly used to treat depression in people of all ages. Some of them have stronger anticholinergic side effects than others, but over all they have a relatively low anticholinergic effect. Other newer antidepressants, including serotonin/norepinephrine reuptake inhibitors such as venlafaxine (Effexor) and atypical antidepressants such as bupropion (Wellbutrin), have a very low anticholinergic effect.

— Anne Fabiny, MD
Editor in Chief, Harvard Women's Health Watch

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