Are commonly used psychoactive medications associated with lower urinary tract symptoms?

Abstract

Purpose: Lower urinary tract symptoms (LUTS) such as urinary frequency and urgency are bothersome and associated with reduced quality of life. Atypical antipsychotics (AAPs) have been implicated in increasing the risk of urinary incontinence. In a large community-based sample of men and women, we examined the associations of AAP and selective serotonin reuptake inhibitor (SSRIs) use with LUTS.

Methods: Data were collected (2002-2005) from a generalizable sample of Boston, MA, USA, residents aged 30-79 (N = 5503). LUTS were assessed using the American Urologic Association Symptom Index (AUA-SI). The prevalence of clinically-significant LUTS was estimated using a cutoff AUA-SI score of 8+ to indicate moderate-to-severe symptoms. Confounder-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated from multivariate logistic regression to estimate the associations for psychoactive drugs used in the previous month (SSRIs, AAPs, both) and LUTS.

Results: Among women, AAP users had a higher prevalence of LUTS (46.2%) compared with SSRI users (23.5%) and those with depressive symptoms not using SSRIs or AAPs (26.3%). Corresponding prevalence estimates among men were 32.7%, 29.8%, and 33.3%. In multivariate models, AAP use was significantly associated with LUTS among women when used either with (OR = 2.72, 95% CI:1.45-5.10) or without (OR = 3.05, 95% CI:1.30-7.16) SSRIs, but SSRI use without AAP use was not associated with LUTS compared with nonusers without depressive symptoms. No associations were observed among men.

Conclusions: In our study, AAPs but not SSRIs were associated with increased prevalence of LUTS among women only. Further prospective research is needed to determine time sequence and cause and effect.

Figure 1

A. Severity of LUTS among men, by SSRI or AAP medication use and depression status. Untreated depression was defined as depressive symptoms without use of SSRIs or AAPs. The SSRI group also contains SNRIs, serotonin modulators, and buproprion. B. Severity of LUTS among women, by SSRI or AAP use and depression status. Untreated depression was defined as depressive symptoms without use of SSRIs or AAPs. The SSRI group also contains SNRIs, serotonin modulators, and buproprion.

Figure 2

A. Mean AUA-SI symptom scores and voiding and storage subscores, by gender, SSRI or AAP medication use, and untreated depression (symptoms of depression without use of SSRIs or AAPs). Higher scores indicate more symptoms. Mean scores for those who were not users of these medications and who did not have depressive symptoms were 3.3 and 3.6, for men and women, respectively. The SSRI group also contains SNRIs, serotonin modulators, and buproprion. B. Mean symptom interference scores, by gender, SSRI or AAP medication use, and untreated depression (symptoms of depression without use of SSRIs or AAPs). Higher scores indicate more symptom interference with activities of daily living. Mean scores for those who were not users of these medications and who did not have depressive symptoms were 1.0 and 1.4, for men and women, respectively. The SSRI group also contains SNRIs, serotonin modulators, and buproprion.