Medicines that can affect mood and memory

Many older adults take several medicines each day. Most of them help. But some common medicines can make a person feel foggy, forgetful, sad, anxious or unlike themselves. These changes are easy to blame on "just getting older" or on dementia, when a medicine may be part of the cause.

The good news is that medicine-related problems can often be found and fixed. This page explains which medicines to ask about, what the Beers Criteria are, and how a medicine review with your doctor or pharmacist works.

Why medicines act differently as we age

Our bodies change with age. The kidneys and liver may clear medicines more slowly, so a drug can build up to levels that are too high.¹ Some sleep and anxiety medicines stay in the body longer, so their effects can last into the next day.³

Older adults also tend to have more than one long-term health problem. That often means more medicines.¹ Each new medicine adds a chance of side effects and of drugs reacting with each other. According to the CDC, bad reactions to medicines lead to more than 700,000 emergency room visits in the U.S. each year. Many of them can be prevented.⁶

Mood and memory side effects are tricky because they come on slowly and look like other problems. A person may seem depressed, withdrawn or forgetful. Family may worry about dementia. Yet a medicine, or a mix of medicines, can cause the same signs. That is why doctors check medicines when someone has new memory problems. See treatable conditions that look like dementia.

What are the Beers Criteria?

The Beers Criteria are a list of "potentially inappropriate medications" for adults 65 and older. The American Geriatrics Society (AGS) keeps the list and updates it on a regular schedule. The newest version came out in 2023.²

The list names medicines that older adults should usually avoid. It also names medicines to avoid only in certain situations, such as with certain health problems.² The AGS says the list should guide shared decisions between you and your doctor. It is not meant to replace a doctor's judgment.²

If one of your medicines is on the list, do not panic. It may still be the best choice for you. The list means the medicine has a higher chance of side effects in older adults, or that safer options may exist.⁴ It is a good reason to ask questions.

Some medicine groups the AGS asks older adults to avoid or use with care include:³

Source for the table: AGS Health in Aging Foundation, based on the Beers Criteria.³

Anticholinergic medicines: a hidden load on the brain

Anticholinergic medicines block acetylcholine (a chemical messenger the brain uses for memory and attention). Many medicines have this effect, even when it is not their main job. They include some older allergy and sleep aids, some bladder medicines, and some older antidepressants.⁵

Diphenhydramine is a good example. It is in many allergy, cold and nighttime sleep products. MedlinePlus advises that most people 65 and older should generally not use it, except for serious allergic reactions, because safer choices exist.⁷ Many people do not know their bedtime pill contains it. Check the "active ingredients" box on the label, or ask your pharmacist.

The effects can add up. Doctors call this the anticholinergic burden. One large study followed 3,434 adults aged 65 and older for about seven years. People with the most use over ten years (more than three years' worth of daily doses) were about 1.5 times as likely to develop dementia as people who did not use these medicines.⁵ This kind of study shows a link, not proof that the medicines cause dementia.⁵ Still, it is a good reason to review these medicines.

Our page on medicines that can worsen memory goes into more detail for people living with dementia.

Sleep and anxiety medicines

Benzodiazepines are used for anxiety and sleep. In 2020, the FDA added its strongest warning, a boxed warning, to all of them. It covers misuse, addiction, physical dependence and withdrawal.¹⁰ Taking them with opioids, alcohol or other sedating drugs can cause serious harm, including death.¹⁰

In older adults, these medicines can also bring confusion and falls.³ Stopping suddenly can cause serious withdrawal, even seizures. The FDA says a doctor should lower the dose slowly, with a plan made for each person.¹⁰ This is a clear case where you should never stop on your own.

For safer ways to sleep and calm anxiety, see sleep medicines: what to know, insomnia and medicines for anxiety. Mixing alcohol with these medicines is risky. See alcohol in later life.

Steroids and mood

Corticosteroids, such as prednisone, are strong medicines for swelling, asthma, arthritis flares and many other conditions. They are not the same as the steroids some athletes misuse.

The FDA label for prednisone warns that steroids can affect the mind. Effects range from feeling unusually happy or wired, trouble sleeping and mood swings, to personality changes, severe depression, and losing touch with reality (psychosis).⁸ Steroids can also make existing mood or mental health problems worse.⁸

If you or a family member start acting very differently while taking a steroid, call the doctor who prescribed it. Do not stop a steroid suddenly after long-term use. The body needs time to adjust, so the doctor lowers the dose slowly.⁸

Beta-blockers: a myth worth clearing up

Beta-blockers, such as metoprolol and propranolol, treat high blood pressure, heart failure and irregular heartbeat. For years, many people believed they cause depression. Some people have been afraid to take them for this reason.

A large 2021 review looked at 285 strict trials with more than 53,000 people. Depression was no more common with beta-blockers than with a placebo (a look-alike pill with no medicine).⁹ The authors said worries about depression should not keep people from heart medicines they need.⁹ Many of the trials had weaknesses, so the evidence is not perfect.⁹

The same review found that beta-blockers may cause some sleep problems, such as trouble sleeping and unusual dreams.⁹ If you notice these, tell your doctor. Do not stop a heart medicine on your own, because stopping some heart medicines suddenly can be dangerous. Your doctor may be able to adjust it.

Other medicines that can affect mood

• Montelukast (Singulair). This asthma and allergy medicine has an FDA boxed warning about serious mental health effects. These include agitation, depression, sleep problems, confusion, memory trouble and suicidal thoughts. The FDA says people should contact a health care professional right away if mood or behavior changes.¹¹
• Opioid pain medicines. Taking them with benzodiazepines or alcohol can be very dangerous.¹⁰ See chronic pain and mood.
• Pain medicines, sedatives and anticholinergic medicines are known triggers of delirium, a sudden state of severe confusion.¹²

The brown-bag medicine review

A brown-bag review is simple. You put every medicine you take into a bag and bring it to your doctor or pharmacist. They look at each one together with you. It is one of the best ways to catch problems.

1. Gather everything. Include prescriptions, over-the-counter medicines, vitamins, herbs and supplements.¹ Add eye drops, creams and inhalers too.
2. Bring the bottles, not just a list. The labels show the real names, strengths and prescribing doctors.
3. Say what worries you. Mention new confusion, low mood, poor sleep, dizziness or falls. Say when it started.
4. Ask about each medicine. What is it for? Do I still need it? Could it cause my symptoms? Is there a safer option?⁴
5. Leave with an updated list. Keep one copy at home and one in your wallet. Give a copy to every doctor you see.¹

Experts suggest asking for a full review once or twice a year.⁶ Using one pharmacy for all your prescriptions helps the pharmacist spot drugs that clash.⁶ A memory notebook is a handy place to keep the list.

Medicare can help. Medicare drug plans must offer a free program called Medication Therapy Management to people who meet certain rules. It includes a full review of your medicines with a pharmacist or other provider, plus a written summary and to-do list.¹³ If you take medicines for more than one long-term condition, call your plan to ask if you qualify.¹³ These rules are current as of October 2026. Read more in what Medicare covers for mental health.

Deprescribing: cutting back safely

Deprescribing means carefully finding medicines whose risks now outweigh their benefits, then lowering the dose or stopping them.¹⁴ A medicine that made sense years ago may no longer fit. Your health may have changed, or your goals for care may be different now.¹⁴

Deprescribing is a planned process with your doctor, not something to try alone.^4,14 Some medicines, such as benzodiazepines and steroids, must be lowered slowly.^8,10 Your doctor may cut back one medicine at a time and check how you feel. If a reaction is confirmed, your doctor may switch you to a different medicine or a non-drug treatment.⁴

Tips for family caregivers

You may be the first to notice a change. Write down what you see and when it began, especially after a new medicine or dose change. If your loved one has dementia, see managing medicines at home and medicines for agitation and behavior.

Hospital stays are a common time for new medicines and for delirium. Bring the medicine list, and speak up if your loved one seems suddenly confused. See hospital stays and emergency rooms. Medicines that cause sleepiness also raise the risk of falls. See preventing falls.

When to get help

Talk with your doctor at your next visit about slower changes, such as low mood, poor sleep or forgetfulness that began after a medicine change. Depression in later life can be treated, whatever the cause. See depression in later life and our help page.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.