Benadryl, Sleep Issues, ADHD, and Elderly Cognitive Decline

I recently posted about alternating Melatonin and Bendadry as a sleep aid for my inattentive son. An astute reader pointed out that Benadryl has been associated with cognitive decline. I had not heard of this finding and so I researched these associations. The best study that I found to support this finding was the study below.

The cognitive decline seen with chronic Benadryl (diphenhydramine) use has been of concern in the elderly because of a number of reasons not the least of which is that the way that drugs are metabolized in the elderly is much different from the way drugs are metabolized in middle age adults or for that matter in children.

There is additional concern with diphenhydramine and its effect on the cholinergic systems which includes the systems that control the neurotransmitters thought to be amiss in ADHD. There are no good studies linking diphenhydramine with increased ADHD symptoms. There is one study that showed just the opposite. It showed that diphenhydramine helped children with learning disabilities or dyslexia and attention deficit disorder.

Sleep deprivation is a major issue in ADHD. A large percentage of children with ADHD also have insomnia. The use of any treatment for insomnia whether it is Melatonin or Benadryl can be risky as we do not know what the long term effects will be.

I must admit that I feel more comfortable with Benadryl than I do with Melatonin. Benadryl has been around for a long time and the adverse events reported from its use are small. Having said that, if I had my druthers and sleep deprivation did not make my inattentive son even more of a walking zombie, I would give him neither.

There are some physicians who believe that ADHD has an allergic component and that avoiding allergens is essential to effective treatment. As I mentioned in my post, I give my son Benadryl for allergies as well as for sleep. The antihistamines were prescribed by his Pediatrician. My inattentive son has a history of seasonal allergies and sinusitis and we live in a city where every season is allergy season.

The pediatrician's recommendation is also part of what makes me feel more comfortable administering Benadryl to him and a bit less comfortable with the Melatonin. The bottom line is that, especially in children, Melatonin is not well studied and not likely to be recommended.

As a parent I approach any medical treatment for my children cautiously. I also appreciate any knowledge regarding possible side effects and adverse events associated with a treatment of medication. Researchers learn more every day about how the medications that we take may affect us in the long term. I am constantly on the lookout for studies that will guide us in the ADHD treatment decisions we make and I whole heartedly thank the reader who led me to the further study of diphenhydramine. I learned a lot which is always a good thing but there is a lot more to learn because Benadryl or no Benadryl, when it comes to treating ADHD, there is no rest for the weary.

Sedative-hypnotic use of diphenhydramine in a rural, older adult, community-based cohort: effects on cognition. 

Basu R, Dodge H, Stoehr GP, Ganguli M.
Division of Geriatrics and Neuropsychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

A group of 1,627 rural southwestern Pennsylvania elderly age 65 and over were followed for 10 years. Use of prescription sedative-hypnotics (primarily benzodiazepines) increased from 1.8% to 3.1%, and over-the-counter sedative-hypnotic use (primarily diphenhydramine) increased from 0.4% to 7.6%. After adjusting for age and sex, diphenhydramine use was associated with higher education and more depressive symptoms, the latter becoming nonsignificant after controlling for initial insomnia. MMSE became significantly associated with diphenhydramine use when 143 subjects with dementia were excluded from the analysis. The association of this drug with cognitive impairment in persons without dementia highlights its potential for causing adverse reactions in older adults. Sedative-hypnotic use of diphenhydramine in a rural, older adult, community-based cohort: effects on cognition. Basu R, Dodge H, et al University of Pittsburgh. Am J Geriatric Psychiatry. 2003 Mar-Apr;11(2):205-13

Dramatic favorable responses of children with learning disabilities or dyslexia and attention deficit disorder to antimotion sickness medications: four case reports. 
Levinson HN. Medical Dyslexic Treatment Center, Great Neck, NY 11021.

Responses of four learning disabled children who showed dramatic improvements to one or more antimotion-sickness-antihistamines and -stimulants are described qualitatively. These cases were selected from a prior quantitative study in which three antihistamines (meclizine, cyclizine, dimenhydrinate) and three stimulants (pemoline, methylphenidate, dextroamphetamine) were tested in variable combinations (using a specific clinical method) for favorable responses by 100 children characterized by diagnostic evidence of learning disabilities and cerebellar-vestibular dysfunctioning. Pending validation in double-blind controlled studies, these qualitative results suggest that the "cerebellar-vestibular (CV) stabilizing" antimotion-sickness medications, Piracetam included, and their combinations may be shown to be therapeutically useful in treating children with learning disabilities or dyslexia and attention deficit disorder.