Ask the Doctor: GERD Meds & Brain Health; Insomnia; Using Calendars and Reminders

Q: I recently started taking a proton pump inhibitor (PPI) for heartburn, but I have heard conflicting news about the safety of these medications. Are there risks of cognition problems and depression associated with PPIs?

A: PPIs work by reducing the amount of acid produced by glands in the stomach lining. They are commonly prescribed to people with gastroesophageal reflux disease (GERD), of which heartburn is a major symptom. In recent years, some research has suggested that the medications may be associated with cognitive decline. Researchers theorized that part of the drugs may cross the blood-brain barrier (which becomes porous with age) and interfere with healthy brain function. Another theory is that the drugs may lead to lower levels of vitamin B12, which can also affect brain function. However, a large population study published earlier this year found that there was no association between long-term PPI use and a decline in thinking skills.

A study published in early 2018, though, did find that the use of certain PPIs (pantoprazole, lansoprazole, and rabeprazole) was associated with a greater risk of depression. This finding is new, and more studies are needed to learn more about any possible depression risks posed by PPIs. This year’s study was an observational study, however, and did not prove any type of cause-and-effect relationship between PPIs and depression.

If you have concerns about the side effects of these drugs, talk with your doctor about alternative treatments for your condition.

Q: Why is it that my mind seems to race at bedtime? I have a million thoughts in my head, and it makes it difficult to fall asleep.

A: You are certainly not alone, as an estimated one in three people have at least mild insomnia. There are, of course, many causes of insomnia, and a busy mind at bedtime is a common one. There are also several possible explanations for your racing thoughts at bedtime. The brain is always “remaking” itself as it processes new information and stores new memories. Studies have shown that this type of activity is elevated in some people with insomnia, making it more difficult to relax and fall asleep. Racing thoughts may also be a sign of anxiety. If you tend to worry about future events, dwell on past events, or feel overwhelmed by your responsibilities, then you may have anxiety.

A therapist may be able to help you deal with your anxiety and manage your thoughts and feelings to help you relax. If you just need to quiet your mind enough to fall asleep at bedtime, try occupying your brain with innocuous, but pleasant activity: Make a list of your 10 favorite books or movies; mentally rearrange the furniture in the lobby of a luxury hotel; imagine all the steps involved in taking a trip, from packing a suitcase, boarding a plane, and arriving at your destination.

Q: I’ve started using calendars, lists, and other reminders more than ever. I find them very helpful, but I wonder if I’m “cheating” by not challenging my brain to keep track of things. Should I change what I’m doing?

A: You can challenge your brain in many ways besides tasking it to keep track of doctor appointments, passwords, errands and other responsibilities. What you are doing is a smart way to stay organized, avoid missing out or losing information, and preserve your independence. If you want to give your brain a workout, you have countless options. Try learning a new language or computer skills, or start a new hobby. Read books and articles which interest you, but contain new and challenging material. Travel, meet new people, or volunteer. You’re only “cheating” yourself if you don’t keep your mind busy with something and stay engaged with other people.

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