What to know about dementia and bladder control

https://www.medicalnewstoday.com/articles/dementia-and-overactive-bladder

There are several types of urinary incontinence. One of these – especially common in people with dementia – is an overactive bladder. This causes the feeling of a sudden and intense need to pee, and frequent peeing.

Medical management of neurogenic bladder with oral therapy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739981/

This is a review of the most current literature on medical management of the neurogenic bladder (NGB) to treat detrusor overactivity (DO), improve bladder compliance and treat urinary incontinence. The use of antimuscarinics, alpha blockers, tricyclic antidepressants, desmopressin and mirabegron will be discussed along with combination therapy to improve efficacy. These medical therapies will be the focus of this review with surgical therapy and botulinum toxin injections being the subject of other articles in this series. 

Imipramine

Imipramine is a tricyclic antidepressant that is currently rarely used for the treatment of depression given the availability of therapy with more favorable side effect profiles. These medications have, however, been shown to relax the detrusor muscle by acting as muscarinic receptor agonist, directly inhibits smooth muscle and also decreases bladder overactivity by blocking the reuptake of serotonin. Other pharmacological effects of imipramine include the peripheral blockade of noradrenaline, stimulating the beta receptors at dome of the bladder which in turn decreases bladder contractility (55). Imipramine has been historically used to treat nocturnal enuresis in children and adults, but has also been effectively used to treat neurogenic DO. Cole and Fried studied the use of imipramine in ten patients with NGB with incontinence secondary to DO. Six patients noted improvements in their urinary incontinence (three with complete resolution of incontinence) and bladder capacity as well as compliance were improved in responders (56).

In clinical trials imipramine has also been shown to increase compliance in the pediatric NGB (57,58). To date, tricyclic antidepressants have no RCTs to support their use for urologic indications and have been related to cardiac events so must be used with caution, especially in the elderly (Table 1).

Imipramine

10–45 mg divided BID or TID

Dizziness, drowsiness, dry mouth, constipation, blurred vision, nightmares, dyspepsia, breast swelling, lethal cardiac arrhythmia at high doses (overdose)