Common psychotropic drugs silently destroy brain function in psychopaths

New research suggests anticholinergic drugs worsen cognitive abilities, but preventing them can restore psychological clarity

Schizophrenia and other psychiatric patients often struggle with memory and thinking issues that may be more disabling than hallucinations or delusions. Now, a comprehensive new study shows that some medications that these patients often prescribe may make these cognitive problems significantly worse.

A meta-analysis published last week in the American Journal of Psychiatry examined 40 studies involving more than 5,000 psychiatric patients. It found that drugs with anticholinergic properties, commonly used to treat side effects of antipsychotics, are closely related to poor cognitive performance in multiple areas of brain function.

“Anticholinergic burden is associated with cognitive impairments observed in psychiatric disorders,” wrote Valentina Mancini, lead author of Oxford University and colleagues. “From a clinical point of view, a gradual decrease in anticholinergic drugs in psychiatric patients can improve cognition.”

Cholinergic connection

Cholinergic neurotransmission plays a crucial role in cognitive processing, a chemical message system in the brain that enables us to learn, remember and think clearly. Cognitive function is lost when drugs block these signals by inhibiting acetylcholine (creating what researchers call “anticholinergic burden”.

Although many psychiatric patients know that medications may cause physical side effects such as weight gain or tremors, few people realize that these medications may impair their psychological clarity. This is especially problematic, as about 80% of psychopaths have already suffered major cognitive impairments, which seriously affects their daily functioning and ability to maintain employment.

The researchers measured the anticholinergic burden in three ways: by measuring the collective anticholinergic properties of all drugs taken by the patient, measuring the anticholinergic activity through direct blood, and studying what happens when patients stop taking these drugs.

Memory and learning hit the hardest

In all cognitive areas of study, speech learning and memory showed the greatest negative correlation with anticholinergic burden. This means that as anticholinergic drugs improve, patients have the greatest ability to learn and remember verbal information.

The researchers found that anticholinergic burden was significantly negatively correlated with multiple cognitive domains, including:

• Global Cognition (r = -0.37)
• Speech learning (r = -0.28)
• Processing speed (r = -0.24)
• Working memory (r = -0.22)
• Note (r = -0.19)
• Execution function (r = -0.17)
• Visual learning (r = -0.17)
• Social cognition (r = -0.12)

Perhaps most notable are the results of the study, which tracked patients after they stopped taking anticholinergic drugs. These show substantial improvements in cognitive function, with the greatest improvements in working memory (d = 0.94) and speech learning (d = 0.77).

Hidden in the obvious sight

The challenge for clinicians is the discovery of anticholinergic properties in many medications prescribed for psychiatric patients. These include not only special anticholinergic drugs used to treat the exercise side effects of antipsychotics, but also many antipsychotics themselves (especially olanzapine, clozapine and quetiapine), as well as certain antidepressants, antibacterials and antihistamines.

This “hidden” anticholinergic burden exacerbates the fact that patients with chronic psychiatric disorders usually have multiple health conditions that require multiple medications.

The researchers noted that although compounds that compete to inhibit the binding of acetylcholine to muscarinic receptors often prescribe acetylcholine to muscarinic receptors for psychiatric patients.

An ignored solution

The results of the study show that mental health professionals should consider reducing anticholinergic drugs as much as possible. This could mean using antipsychotics with lower anticholinergic properties, thus minimizing the use of anticholinergic drugs for side effects or exploring non-pharmaceutical approaches.

The World Health Organization has recommended prevention and long-term use of anticholinergic drugs in psychiatric patients. Nevertheless, they are still widely prescribed and many patients prolong it.

The researchers warn that their findings are based primarily on observational studies and require more certain randomized clinical trials. They noted that the tapering study was not blind and lacked a control group, which meant that improvements could partially reflect the practical impact of repeated tests.

However, the consistency of findings across different measurement methods enhances the conclusion that anticholinergic drugs are causing real cognitive harm to many psychiatric patients.

For millions of people with schizophrenia and other psychotic disorders around the world, cognitive impairment often persists even if other symptoms are controlled. These cognitive difficulties can severely limit rehabilitation, employment opportunities and overall quality of life. If something as simple as medication adjustment can improve these obstacles, it may represent a significant advance in treatment.

Meanwhile, patients should not stop taking medication without medical supervision, but rather they may want to discuss the anticholinergic properties of their medication regimens with healthcare providers to see if alternatives can be used.