Doc: Meds, Alzheimer’s disease link?
Dear Dr. Roach: I read recently that if Valium is taken by older folks for more than 90 days, it ups their risk for Alzheimer’s disease by 32 percent and if taken for more than 180 days, the risk goes up 84 percent. Have you heard anything like this? Why would this be prescribed if this is true?
What is safe for seniors, or anyone, to take for anxiety? We all go through rough spots in life that need some internal quieting. I know lots of people take a drink, but that is not something I do.
Dear C.P.: A study published just a few months ago in BMJ, a prestigious medical journal, showed a clear association between benzodiazepines — a class of medications that includes diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax) and lorazepam (Ativan), among many others — and Alzheimer’s disease. The association was stronger for long-term use than for short, as you correctly point out. Further, the risk was higher for long-acting drugs (like Valium or Librium) than for short (like Xanax).
However, the type of study done cannot claim that taking the medication caused the increased risk of Alzheimer’s. The authors themselves point out that it is possible that early Alzheimer’s disease causes anxiety that is subsequently treated with prescription anti-anxiety medications, and that there is no causal relationship. It is also possible to see this result from chance, although the authors found less than 0.1 percent likelihood this result is due to chance alone. Finally, it’s possible that there is both a direct, causal link between taking benzodiazepine drugs and developing Alzheimer’s disease and that early Alzheimer’s causes some people enough anxiety that they are prescribed these anti-anxiety medications. That implies that the risk is less than the numbers from the study. A different study design is necessary to try to discover which of these possibilities is the truth.
There are many good reasons not to use benzodiazepine medications, and I never prescribe them for long-term use. Increased risk of both falls and automobile collisions are two that most concern me. (Multiple studies have confirmed this risk, so it is likely that these drugs do cause some people to fall and to have auto accidents.) These are also potentially habit-forming medications, and sometimes it becomes very difficult to sleep without them once they are started.
Because all medications have some risk, I recommend nondrug strategies for anxiety reduction. Meditation, mindfulness and imaging exercises, yoga and even regular exercise all have been shown to reduce anxiety without medication. Counseling and cognitive-behavioral therapies also are effective. If medications are needed, then SSRI medications such as sertraline (Zoloft) have lower risks than benzodiazepines. Just a cup of hot chamomile tea might help you get through stressful times.
Dear Dr. Roach: What are your thoughts about the MiraDRY procedure to get rid of underarm sweat? Is it safe not to have sweat under the arms?
Dear S.J.: MiraDRY is the brand name of a microwave device designed to treat hyperhidrosis (excessive sweating). This is a condition of abnormal, drenching sweat that greatly interferes with social activities, not normal underarm sweating. It is currently used only for underarms — not hands, feet or face, the other most common places for localized hyperhidrosis. According to several published papers, the microwaves heat up the water in the sweat glands, destroying them, while the skin itself is cooled.
The published success rates (at reducing sweating to “never noticeable” or “tolerable”) are very high, as are patient satisfaction results. Side effects included swelling, redness and temporary numbness.
This is a new procedure, but it appears to have promise in the treatment of excess sweating. I also found a very helpful website at sweathelp.org.
Email questions to ToYourGoodHealth@med.cornell.edu.