Relationship Between Psychiatric Drug Use and Cognitive Function in Women During the Menopausal Transition: An Analysis Based on the NHANES Database

Abstract

Background: Women during the menopausal transition often experience mood disorders, sleep disturbances, and cognitive decline, making the use of psychotropic drugs relatively common. However, the relationship between psychiatric drug use and cognitive function in menopausal women remains unclear.

Methods: This was a cross-sectional study that included women aged 45–65 years from the National Health and Nutrition Examination Survey (NHANES) 2021–2023 cycle. Psychiatric drug use was defined based on prescription drug data, including antidepressants, benzodiazepines, and sedative-hypnotics. Cognitive function was assessed using the Digit Symbol Substitution Test (DSST). The Bayesian Kernel Machine Regression model was used to analyse the relationship between psychiatric drug use and cognitive function, with adjustment for potential confounders, including routine demographic characteristics.

Results: A total of 956 women during the menopausal transition were included in the analysis. As the number of psychotropic drugs used increased, cognitive function decline became more pronounced. Antidepressants and benzodiazepines played dominant rolesin this association (posterior inclusion probability >0.9). The concurrent use of two or more psychotropic drugs was associated with an 11%–24% reduction in DSST cognitive scores. In the context of three-drug combinations, the cognitive impairment associated with antidepressants and benzodiazepines were amplified, resulting in an additional 5.1%–6.3% decrease in cognitive scores. 

Conclusions: Psychiatric medication use showed a significant cross-sectional association with poorer cognitive performance among women undergoing menopausal transition, and polypharmacy regimens displayed stronger associations than single-drug regimens. Clinically, greater attention should be paid to the potential cognitive impact of psychiatric drug use in menopausal women, and polypharmacy regimens should be optimised.