OTHER CASES OF ELDERLY PERSONS WITHOUT
PERIPHERAL URINARY PROBLEMS, WITH NOCTURIA REDUCED OR DISAPPEARED FOLLOWING AN
ANTIDEPRESSANT AND ANTISTRESS DRUG THERAPY.
Renato COCCHI, a neurologist and a medical
psychologist.
(Other seven cases of drug treated nocturia)
Summary.
In 10 patients (six females and four
males; average age: 62.9 years at the first visit, with 19-85 years' range) all
affected by nocturia, it was observed that by drug modulation of stress
answers, the nocturia missed in eight out of 10, considering normal one
awakening for each night. In four cases out of 10 the sleep did not have any interruption.
The nocturia is a not exclusive stress symptom of the elderly, linked to
nighttime parasympathetic overstimulation of brain origin, elicited, in the
elderly, from the same aging, as a stress cause. The nocturia elicits an
increase of the stress state, by alteration of the sleep-waking rhythm. By this
way in the elderly it increases the falling frequency, sometimes with damage,
in all persons it induces decreased vitality during the day.
Key words: Nocturia, stress, nighttime
awakening, prevalence, elderly, falls, damage, vitality, drug therapy, results,
cases.
Drug modulation of stress reactions
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Following the article on the nocturia in the
elderly without peripheral urinary problems, and his resolution with
antidepressant and antistress drug therapies (Cocchi, 2004), I wanted to list
here new cases that came to my observation.
Here, for now, there will be only the cases,
but I intend to add a summary of data and a discussion not just these new case
histories will reach a minimum consistence (at least 10 new subjects).
The numeration continues from that of the
preceding casuistry. For the revision of the literature and for the discussion
I send back, for now, to the first article.
New case histories.
Case no. 8: Second ten days of September
2004. m, of 66 years at first consultation.
He is suffering from subjective vertigoes
from at least two months, irritability ("nervousness") and memory
deficits. The objective neurologic examination does not signal alterations, nor
troubles of the cerebellar function. Walking is in a normal way.
Systemic illnesses do not result, but
essential hypertension, for which he assumes furosemide, one tablet of 25mg
every day. Blood tension runs 90-130, with 71 pulsations per minute.
During the night, he wakes 2-3 times to
urinate.
Test therapy (daily doses, by the oral via):
Amitryptiline 6mg; Glutamine 125mg; 5-Hydroxitriptophan 50mg; Pyridoxine 75mg;
Oxazepam 7.5mg.
Second ten days of December 2004, the second
checkup after 97 days from the beginning of the drug therapy.
He did not have the need get up at night to
urinate, for which he sleeps till the morning.
Current therapy (daily doses, by the oral
via): Amitriptyline 8mg; glutamine 125mg; 5-hyidroxitriptophan 50mg; Pyridoxine
75mg; Oxazepam 15mg.
This case has a wide description in
<www.stress-cocchi.net/Other16.htm>
Case no. 9, June 2004. Female, 75 years old,
came to consultation for troubles of the memory, frequent dyslalias, frontal
headache, confusion, reduced language and reactive depression (as to said by
her daughters) following her husband death, which happened four years ago. She
is taking delorazepam 0.5mg. She seems to have depressive false dementia.
Every night, she wakes 3-4 times to go to
urinate.
Test therapy (daily doses, by the oral via):
Amitriptyline 6mg; Delorazepam 0.5mg; Carbamazepine 100mg; 5-hydroxitryptophan
25mg.
February 2005, the second checkup: She is
doing decidedly better, under all the aspects. I confirmed the hypothesis of
false dementia. Now, she is waking once every night to go to the bathroom.
Current therapy (daily doses, by the oral
via): Glutamine 125mg; Amitriptyline 6mg; delorazepam 0.4mg; Carbamazepine
100mg; 5-hydroxitryptophan 25mg.
Case no. 10. NOT AN ELDERLY PERSON. First
days of October 2003, first consultation. A male, 19 years old, an autistic
adult, already autistic as a child.
He is aggressive, against the things,
against himself, and against the other, mainly against the already elderly
parents. He has troubles of the sleep, with difficulty in falling asleep,
frequent sleep wakes up (he needs to go to bathroom 3-4 times every night), and
early morning awakening.
Test therapy (daily doses, by the oral via
): Carbamazepine 300mg; Delorazepam 0.5mg; Amitriptyline 1mg; Clonidine
0.075mg.
First ten days of February 2005: The fourth
checkup. At night he does not need to go to bath room to urinate.
Prescribed therapy (daily doses, by the oral
via):
S-adenosil-l-methionine 200mg; Clonidine
0.075mg; Amantadine 25mg; Delorazepam 0.5mg; Amitriptyline 10mg; Carbamazepine
400mg.
I described extensively this case on
<www.stress-cocchi.net/Autism14.htm>.
Case no. 11. THIS IS NOT AN ELDERLY PERSON.
Beginning January 2005, first consultation. A woman, 33 years old, depressed,
with two-three relapses every year. She suffers from the sclerodermia. Usually,
she has sudden bursts of anger and aggressiveness against her grandmother and
the man living with her, mainly during the menstrual period. At night she needs
to get up 2-3 times to go in the bathroom to urinate, in spite of the choice of
reduced drinking in the evening.
Test therapy (daily doses, by the oral via):
Pyridoxine 75mg; Diazepam 2mg; Glutamine 125mg; Amitriptyline 6mg.
March 2005, the second checkup, after 75
therapy days. At night she does not need more to go to the bathroom. Less
bursts and aggressiveness occur. The EEG is altered
Current therapy (daily doses, by the oral
via): Diazepam 1.4mg; Pyridoxine 75mg; Glutamine 125mg; Amitriptyline 6mg:
Carbamazepine 200mg.
In future, I shall report this case in
extent.
Case no. 12. Beginning February 2005, the first
consultation. A woman of 79 years, depressed, with intrusive thinking,
mediastinal oppression, lump in the throat, air hunger and mental confusion in
the morning. She sleeps badly and she has to get up 3-4 times every night to go
in the bathroom to urinate.
Test therapy (daily doses, by the oral via):
Pyridoxine 75mg; Amitriptyline 6mg; Octatropine methylbromide 40mg + diazepam
5mg.
First ten days of April 2005: The second
checkup, after 58 days of drug therapy. Some night she has to get up once to go
to the bathroom, but often sleeps till the morning. Nocturia is not more
pathological or missing.
Current therapy (daily doses, by the oral
via): Diazepam 4mg; Pyridoxine 75mg; Amitriptyline 6mg: Carbamazepina 100mg;
Glutamine 125mg.
Case no. 13, half April 2004, the first
consultation. A man aged 81 years, with dementia behaviour. Probably is a form
of false dementia in a large extent due to a not much evident senile depressive
base, and some problems of brain blood circulation. He has 3-4 nocturia
episodes every night. Now he takes delorazepam 0.5mg and promazine 7mg.
Test therapy (daily doses, by the oral via):
Carbamazepine 100mg; Delorazepam 0.5mg; Promazine 6mg; Amitriptyline 4mg;
Dihydroergotoxine mesilate 0.3mg.
April 2005, the second checkup: Well
psychically adjusted with some deficits due to his age. Nocturia 1-2 episodes
every night.
Current therapy (daily doses, by the oral
via): Carbamazepine 100mg; Delorazepam 0.5mg; Promazine 4.5mg; Amitriptyline
4mg; Dihydroergotoxine mesilate 0.3mg; A polyvitaminic compound with mineral
salts (Supradyn Roche TM) two soluble tabs every week.
Case no. 14, half April 2005, the first
consultation. A woman of 85 years, in more than discreet psychophysical conditions
till after flu treated with antibiotics, in the last March. From then she had
disturbed sleep, is confused, abulic and seems intellectually deteriorated. A
woman geriatrician has diagnosed senile dementia and prescribed haloperdol
2.5mg and lorazepam 1.25mg (daily doses, by the oral via). About surely we are
dealing with a false dementia on a depressive base. Nocturia amounts of 3-4
episodes every night.
Test therapy (daily doses, by the oral via);
Haloperidol 0.5mg; Lorazepam 1.25mg; Glutamine 125mg; Thiamine 125mg +
pyridoxine. B6 125mg + cyanocobalamine 500mcg; Carbamazepina 100mg;
Amitriptyline 6mg.
Near end May 2005, The first checkup after
42 days of drug therapy. The false dementia aspects nearly recovered. She came
back to psychophysical conditions she had before the influenza episode.
Nocturia is now 0-1 time for night.
Current therapy (daily doses, by the oral
via); Haloperidol stopped. Lorazepam 1.25mg; Glutamine 250mg; Thiamine 125mg +
pyridoxine 125 mg + cyanocobalamine 500mcg; Carbamazepine 100mg; Amitriptyline
8mg; A polyvitaminic compound with mineral salts (Supradyn Roche TM) one
effervescent cp every week.
Case no. 15, a man of 59 years, already seen
in 2003 for a depression that started 16 years before. After some months he
stopped the prescribed therapy, by his will, without coming back for the check.
Seen again in the February 2005, its depression has been diagnosed as recurrent
atypical depression. He wakes up 3-4 times every night to go to the bathroom to
urinate. He suffers from subjective vertigo.
Test therapy (daily doses, be the oral via):
Glutamine 125mg; Pyridoxine 75mg; Amitriptyline 20mg; Bromazepam 1.5mg.
Starting May 2005: The first checkup. He is
now less depressed and anxious. The vertigo disappeared. An intermittent
tinnitus to both ears came out, that seems the puff of an inner wheel rubber
that is deflating because punctured.
Therapeutic variations (daily doses, by the
oral via): Glutamine 250mg; Carbamazepine 100mg.
Case no. 16, end March 2005, a woman of 79
years, coming to consultation for senile depression of inhibitory type. She has
a current therapy with octatropine methylbromide 30mg + diazepam 5mg. She has
asthenia and memory problems. She sleeps badly because she needs to go in the
bathroom to urinate 3-4 times every night.
Test therapy (daily doses, by the oral via):
Octatropine methylbromide 20mg + diazepam 1.7mg; Amitriptyline 6mg;
Carbamazepine 100mg; Glutamine 125mg; a polyvitaminic compound with mineral
salts, 1 tablet every week.
Half May 2005, the first checkup. Her mood
has much improved, as the memory too. Rarely she is asthenic. Now she sleeps
all the night or has only one need to go to the bathroom to urinate.
Therapeutic variation (daily doses, by the
oral via): Octatropine metilbromide + diazepam stopped. I prescribed: Glutamine
250mg; Amitriptyline 10mg; Oxazepam 15mg.
Case no. 17, end March 2005. A woman of 53
years, who came for consultation for 3-4 times nocturia every night. She is
even depressed, with easy weeping, mediastinal oppression, intrusive thinking
and frequency of scary dreams.
Test therapy (daily doses, by oral via):
Glutamine 125mg; pyridoxine 75mg; Carbamazepine 100mg; Amitriptyline 8mg;
Lorazepam 0.5mg.
Half May 2005, the first check after 49 days
of drug therapy. For 15 days the therapy does not seem working, then were
progressive improvements. The nocturia is currently 1-2 times for night, rarely
3 times. Her mood has clearly improved, but she was still with some depressive
moments and symptoms of parasympathetic overstimulation.
Therapeutic variation (daily doses, by the
oral via): Amitriptyline 10mg; Lorazepam 1.0mg; Carbamazepine 200mg.
Summary of results
Tab. 1: Summary of drugs used (daily doses,
by the oral via) and results.
|
Drugs |
Mg doses |
Pazients' no. |
||
|
Glutamine |
125-250 |
8 |
||
|
Pyridoxin |
75-150 |
4 |
||
|
Carbamazepine |
100-400 |
9 |
||
|
Amitriptyline. |
4-20 |
10 |
||
|
Oxazepam |
7.5-15 |
2 |
||
|
Lorazepam |
0.5-1.25 |
2 |
||
|
Delorazepam |
04-05 |
3 |
||
|
Bromazepam |
1.5 mg |
1 |
||
|
Diazepam |
1.4-4 |
2 |
||
|
S-adenosil-l-methionine |
200 |
1 |
||
|
Clonidine |
0.075 |
1 |
||
|
Octopamine mbr+ diazepam |
20-40 + 2.5-5 |
2 |
||
|
5-hydroxy-triptophan |
25-50 |
2 |
||
|
Promazine |
4.5-6 |
1 |
||
|
Haloperidol |
0.5 |
1 |
||
|
Amantadine |
20 |
1 |
||
|
Diidroergotossina mesilato |
0.3 |
1 |
||
|
Polyvitaminic with mineral salts |
1 tab x week |
3 |
||
|
Vit. B1+B6+B12 |
125+125+0.5 |
1 |
||
|
|
||||
|
Totals of drugs |
18 // Average drugs for patient: 5.5 |
|||
|
|
||||
|
Results on the nocturia |
Missed |
8 out of 10 = 80% |
||
|
From 0 to 3 episodes |
Intermittent |
2 out of 10 = 20% |
||
|
Night awakenings |
Stopped |
4 out of 10 = 40.0 % |
||
The nocturia missed in 8 out of 10 patients,
and 4 out of 10 patients stopped to awake nighttime. The drugs prescription was
individually tailored.
Discussion.
Even in this new survey, already from its
title, it seems to exclude the so-called "overactive bladder" as a peripheral
urinary problem. So, not because there is not an overactive bladder, but
because, as for me, it is not a primary problem. Even it would be the result of
a fluctuating parasympathetic outflow coming from the brain, as stress
reaction.
However, in both the patients who already
took octopamine methylbromide + diazepam, a similar hypothesis could have been
the base of such previous prescription.
In most cases, this result did not look for,
but the case history of the person with the no. 17 came to visit exactly for
nocturia. First results are much encouraging. The fact that six cases out 10,
concerns women, by now it is only confirmation of the previous research
(Cocchi, 2005). It is possible that it means aspecific prevalence of this
symptom in females, as creditable to the greater easiness of the women, even
elderly, to have depressive pathology. It could even be truly casual.
In all these 10 patients I prescribed a
tricyclic antidepressant, sometimes by replacing the antidepressant previously
taken. The peripheral anticholinergic (antispasmodic) action of the tricyclic
antidepressant may have contributed to the improved control on emptying of the
bladder, by an action on the detrusor muscle.
Surely the action against the nocturia is
not exclusive. Like a peripheral antispasmodic drug, two patients assumed
octopamine methylbromide, with a poor result, if not null.
None of them had assumed desmopressine
acetate, the synthetic analogous of the natural antidiuretic hormone, which
could reduce the urinary outflow, so reducing the bladder filling and the
emptying stimulus.
I acted on the depression, with the
tricyclic drugs, the 5-hydrixytriptophan, and the S-adenosil-l-methionine, and
on the stress reactions with the benzodiazepines, the glutamine, the pyridoxine
and the carbamazepine. The result on the stress was surely wider, the sleep
improved, as too the mood. To notice, eventually, the nocturia in four cases of
not elderly persons, with stress symptoms. This is confirmation that the
symptom is not specific of the elderly persons, and it is strictly correlated,
if not caused, by a stressful state.
Conclusions.
The nocturia, as awakening out of the need
to urinate, is a trouble in prevalence of the elderly, probably linked to
internal stress from aging, but it may be found even in not elderly persons,
during stress conditions. By his way it leads to an increasing of the stress
conditions, by making worse the sleeping-waking rhythm.
In the 10 cases here reported, it happened
that by modulating with drugs the stress answers, the nocturia missed in eight
of them, if we consider as normal an only nighttime awakening. In four cases
out of 10 no nighttime awakenings persisted.
References.
Cocchi R. The nocturia ( or nycturia ) in elderly persons without peripheral urinary problems can be reduced or abolished with an antistress drug therapy? Preliminary report on 7 cases treated with antidepressant-antistress drugs. 2004 <www.stress-cocchi.net/Other15.htm>
Posted on Internet on 1 March 2005. Copyright by Renato Cocchi, 2005.
Author's address: Dr Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
Drug modulation of stress reactions
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