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What causes frequent urination along with depression?

DOCTOR OF THE MONTH - Jan 2017
Jan 2017
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Answered by

Cardiologist
Practicing since : 2013
Answered : 1447 Questions
Question
Hello,
I have taken advice on this site in the past which I hope you are able to refer to.
I am now 79 and pretty good I suppose for my age.
However, I do not feel that well and the NHS frustrates me with GPs having insufficient time to consider patients.
My brief health summary is —-
I get high BP and constant urination. I do get headaches at night with nightmare type stressful dreaming. I also have erectile dysfunction.
Recently I had a private health check with all results OK except for —-
Red blood count slightly low. Slight dehydration. A chest Xray revealed no problem except for an unbending aorta. Also continued high BP.
My own monitoring reveals that my BP early AM is 125/82 average. In the afternoon my BP rises to 150/90 average and by the evening as high as 160/100.
I can sense it when it is high with flushing.
My urination appears to be OK until the afternoon when I am sometimes peeing every thirty minutes. My prostate has been slightly enlarged for 10 years on “watch and wait”
I have tried four of the usual BP meds. They all caused headaches so I try to watch my diet by eliminating salt and alcohol. I do drink average amounts of coffee and tea.
I do not take any medication currently.
I do moderate exercise in a gym 3 times per week.
My lifestyle has been many years in business and still the chairman of a fair sized retail company. I am happily married with large family. Never smoked. Not overweight. Music and guitar is my hobby..
I had a nervous breakdown at the age of 53 with several years of depression which followed. Nowadays my mental health is good. I do meditate sometimes to bring my BP down. It does seem to help.
To sum up it is the bouts of endless urgent visits to the toilet which worries me along with the erectile problem. My GP suggest I visit a cardiologist but fails to refer me. I welcome your comments.
 
 
Answered by Dr. Sagar Makode 40 minutes later
Brief Answer:
Its likely a BPH causing frequency of urination

Detailed Answer:
Hello,
I have gone through your history.
1. Frequency of urination: It's likely a result of BPH, enlarged prostate which leads to inadequate emptying of bladder and leads to increased frequency. I guess your sugars are normal. So treating BPH should help in reducing frequency. We usually give Tab Urimax D ( Tamsulosin 0.4 and dutasteride 0.5 mg) bedtime which has good results in patients. So you can ask for the same.
2. For bp, if you are planning to start Urimax, then it's better to wait for a week after initiation, as it can lower the bp itself. Otherwise, you need to be on low dose bp medicine in the morning so it will take care of afternoon and evening surges. All bp medicines should not give you headache, may be some psychological component. Various options available are Amlodipine, telmisartan, chlorthalidone, Metoprolol, ramipril etc. You can mention, which one you had. I would say, you get started Tab Telmisartan 20 mg in the morning from your doctor if possible.
3. Erectile dysfunction, we usually give Sildenafil in dose 50 mg once daily 1 hour ( 30 minutes to 4 hours) before sexual activity as needed. Starts with 25 mg and if tolerated well we maintain on 50 mg and may increase upto 100 mg. So you can get prescribed from local doctor.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by
 
Follow-up: What causes frequent urination along with depression? 1 hour later
Doctor Makode, Thank you for your prompt reply.
Just to confirm. Are you saying that by treating the BPH first this may lower my blood pressure. That is very interesting.
The suggestion of my GP that an anti depressant may help. I did not follow that advice as I associate them with my depressive episode. I am a nervous person which no one believes as outwardly I appear confident. Type A high achiever type in spite of my hidden shyness.
Regarding the urination. Tests have always shown that I do in fact completely empty my bladder. It’s as if my bladder just kicks off at times, usually later in the day, when I keep having to urinate time after time. Then it settles down and during the night only have to make a couple of visits.
Thank you again.
 
 
Answered by Dr. Sagar Makode 1 hour later
Brief Answer:
So it's overactive bladder

Detailed Answer:
So your test suggests it to be an overactive bladder. In that case too, you have option of anticholinergic medicine like Tab Tolterodine which is taken twice a day and later reduce to 1 mg twice a day after response. It helps a lot in terms of symptoms. Neurologist can guide you much in this problem.
Treating your urinary symptoms with Urimax, may lower your bp as this medicine is alpha blocker and vasodilates vessel leading to lowering of the bp. All the best.
Above answer was peer-reviewed by
 
Follow-up: What causes frequent urination along with depression? 48 hours later
Doctor, forgive me for bothering you once again.
I plan to visit a private GP to discuss your comments and rely on her for advice on referral if needed.
Observing my symptoms in the past few days it does seem that my raised BP is usually linked with increased urination. I cannot work out which cones first. One thing I did not mention that my stream is strong and I produce significant quantities of urine with each visit. Anxiety has often been suggested.
You mentioned that reducing urination with medication may reduce BP.
Is it possible that an anti depressant may improve both BP and excessive urination?
My wife is convinced that I bring on my symptoms by being anxious. I find that hard to believe but cannot argue as have always been nervous.
Is this a urological problem neurological. Your opinion is really valued as my condition is effecting my general well-being.
I write this at 9pm feeling hot and flushed and having to urinate every 30 minutes.
I know my BP would be 160/100 without using the monitor.
Thank you for your assistance. This is a marvellous service.
 
 
Answered by Dr. Sagar Makode 5 hours later
Brief Answer:
Bladder problem is neurological

Detailed Answer:
Hello,
Your bladder problem seems to be neurological and prostate problem as a cause of it is less likely.
Treating your anxiety, nervousness will bring down your bp, but may not in completely normal range. I think you also have age component and arteriosclerosis component as well in elevated bp.
Antidepressants may help to some extent but anticholinergic like Tolterodine, darifenacin, oxybutynin Will be of great help.
Anyway, you should have low salt diet, healthy diet and exercises. You should try to get it bp below 140/90 mmhg by any means.
All the best.
Above answer was peer-reviewed by
 
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