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U.VA. RESEARCHERS FIND POSSIBLE CHEMICAL LINK BETWEEN URINARY INCONTINENCE AND DEPRESSION

Nearly four million Americans suffer from a type of urinary incontinence that, until now, has had few treatments. But some relief may be in store. Researchers at the University of Virginia Department of Urology and Walter Reed Army Medical Center have found that a brain chemical called serotonin, which malfunctions in people with depression, may also be linked to urge incontinence from an overactive bladder. That means antidepressant drugs used to block serotonin absorption in the brain may also help patients manage urge incontinence.

Some incontinence results from stress – bladder muscles weaken through aging, physical stress, such as coughing, or neurological disorders. Urge incontinence, however, can be inherited and often begins in childhood.

Results of the study were published in the July 1999 issue of The Journal of Urology. Co-author Dr. William D. Steers, chairman of U.Va.'s Department of Urology, said, The bladder is a window onto the nervous system – any anxiety originating in the nervous system results in bladder complaints. The majority of patients who have overactive bladders have a history of treatment for depression.

Incontinence may also reinforce depression because it contributes to social isolation. It rates very high as one of the most distressing problems, because people are urinating every 15 minutes or half-hour, and they can't go out and are losing sleep, Steers said.

Urge incontinence from an overactive bladder, such as in patients with serotonin-related disorders, is more difficult to treat than stress-caused incontinence, according to Steers. There are only a few drugs to treat this type of incontinence, and if those don't work, patients are often out of luck. We really need a home-run in finding new treatments for overactive bladders, he said.

The study included 115 incontinent patients, who were compared to a control group of 80 who were continent. All groups were tested for depression and queried about having a history of depression. Steers and his colleagues found either a history of depression or current depression in 60 percent of the patients having urge incontinence specifically from an overactive bladder. Patients with stress incontinence or urge incontinence from neurological disorders or obstructions were not any more inclined to have depression than the control group with no incontinence problems.

This link may be due to altered serotonin function and may help explain the efficacy of serotonergic-based antidepressants in the treatment of urge incontinence, Steers said. Serotonin deficiency may also explain the higher rates of depression and incontinence that exist in women, because men synthesize the chemical at a 52 percent higher rate.

Steers said his research team is applying for National Institutes of Health funding for a large-scale project to determine whether treatment of depression with certain drugs influences bladder function.

More than 13 million Americans suffer from urinary incontinence, according to the National Institute of Diabetes, Digestive and Kidney Diseases.

September 10, 1999