Do you take medication for acid reflux, allergies, anxiety, birth control, blood pressure, or pain? If so, depression or suicidal thoughts may be listed as a side effect, and those side effects may occur far more often than we realized.
- At risk of depression and suicide
- Likelihood of depression from medication
- Medications with depression as a side effect
- What does this mean for you?
- Many commonly prescribed drugs linked to depression
- Where did the story come from?
- What kind of research was this?
- What did the research involve?
- What were the basic results?
- How did the researchers interpret the results?
- Links to the headlines
- Links to the science
- Medications That Can Cause Depression
- Antidepressants and murder: case not closed
- The Relationship Between Antidepressant Initiation and Suicide Risk
- Prescription Drugs That Cause Depression
- Drugs With Depression as a Side Effect
- Are Your Drugs Causing Depression?
- Prescription Drug-Induced Depression Treatment
- 37% of US Adults Are Using Common Meds They Don’t Realise Could Cause Depression
At risk of depression and suicide
A recent study published in JAMA found that people who take medications with depression or suicidal thoughts listed as a side effect are, in fact, more likely to be depressed or suicidal. Researchers looked at data collected between 2005 and 2014 from the large and ongoing National Health and Nutrition Examination Survey, conducted by the US government. This included responses from a nine-item depression and suicidality questionnaire.
In addition, the study found that 37% of respondents used at least one prescription medication with depression as a side effect, that use of these medications had significantly increased between 2005 and 2014, and that people who took them were more likely to be older (65 or older), female, widowed, and have other chronic health problems. For people taking no medications with depression as a side effect, the likelihood of having depression was 5%, and this remained stable regardless of how many other medications they took that did not have depression as a side effect (even if that number was zero).
Likelihood of depression from medication
What was striking was that the likelihood of depression increased significantly for each medication with depression as a side effect a person was taking. For one such medication, the risk was 7%; for two it was 9.5%, and for three or more it was 15%. Put another way, people who took two medications with depression as a side effect had double the likelihood of having depression as those who took none; people who took three had triple the likelihood. They ran the same analysis for medications with suicidal thoughts as a side effect, even correcting for those who were also on antidepressants (and perhaps already at risk for having those thoughts). Those who took no medications with suicidal thoughts as a side effect had a 5% likelihood of having suicidal thoughts. The likelihood of suicidal thoughts increased significantly for each medication with suicidal thoughts as a side effect, so for people taking one it was 8%, for two it was 12%, and for three or more it was 18%.
Also interesting were the findings when the analysis was limited only to people taking antidepressants. Just like everyone else, the more medications with depression as a side effect they took, the higher their risk of depression. So, for people on an antidepressant who took no medications with depression as a possible side effect, the risk of depression was 14%, for one it was 18%, for two it was 27.5%, and for three or more it was 28%.
Medications with depression as a side effect
What are the medications with depression as a side effect? These were among the most common ones listed:
- acid reflux medications like omeprazole, esomeprazole, ranitidine, and famotidine
- allergy medications like montelukast and cetirizine
- anxiety medications like alprazolam, diazepam, and lorazepam (and the sleep medication zolpidem)
- birth control and hormone therapy, which includes anything containing estrogen
- blood pressure medications like atenolol, metoprolol, enalapril, and quinapril
- pain medications like ibuprofen, cyclobenzaprine, hydrocodone, and tramadol
- antiseizure medications (which are often used for other reasons too) like gabapentin, topiramate, and lamotrigine.
What does this mean for you?
This study is especially thought-provoking, given that more and more people are taking medications with depression or suicidal thoughts as possible side effects. The CDC just released updated data showing a troubling recent rise in suicide rates, and that 54% of those who die from suicide do not have a known mental health disorder, so this is an important public health issue.
That said, it is important to note: in this study, people who used these medications were more likely to be widowed and have chronic health problems, both of which are associated with a higher risk of depression. And many (but not all) of these medications are often prescribed to treat symptoms associated with existing depression, such as anxiety, insomnia, pain, and even acid reflux (chronic stress can cause acid reflux).
The next step is to run a study where people are randomly assigned to take these medications, or alternate ones without depression as a side effect, and then follow them over time to see what happens. That’s a randomized, controlled, clinical trial, the gold standard in research studies.
While we’re waiting for that to happen, if you’re suffering from depression, and you’re also taking any of these listed medications, then you may want to consider talking to your doctor about switching to something else for a while, and see if your mood improves.
“Could your medications be making you depressed?” asks BBC News, reporting on a new US study looking into possible links between prescription drugs and depression.
Researchers looked at prescriptions issued to 26,192 adults in the US between 2005 and 2014. They found that more than a third had used medicines with depression as a possible side effect. The results showed that around 1 in 7 people had depression among those taking 3 or more such medicines, compared to around 1 in 20 among those not taking any medicines linked to depression.
There are reasons to be cautious about the findings, however. Many medicines have a long list of potential side effects, which doesn’t mean that everyone taking them will get any or all of those side effects. Also, people taking 3 or more medicines are more likely to have a long-term condition than people taking no medicines. Having a long-term health condition is known to increase the risk of depression, regardless of any medication side effects.
If you are feeling down, it’s a good idea to talk to your doctor. One of the things they can consider is whether any of the medicines you are taking could be contributing to the problem.
Where did the story come from?
The study was carried out by researchers from the University of Illinois and Columbia University in the US. One of the researchers received funding from the Robert Wood Johnson Foundation. The study was published in the peer-reviewed medical journal JAMA.
BBC News’ report of the study was broadly accurate and balanced. The Mail Online claimed people were unaware that their medications’ potential side effects included depression, although nothing in the study suggests this is the case.
The Mail Online also misreported the figures, saying at one point that nearly 25% of people studied were taking 3 or more drugs linked to depression and at another point that this figure was 35%, when the true figure was 7.5%.
What kind of research was this?
This was a cross-sectional study of a sample of the US population. Cross-sectional studies are good at establishing links between factors seen in large populations. However, they cannot show that one factor (such as medication use) directly causes another (such as depression), partly because they cannot show which happened first.
What did the research involve?
Researchers used data from the US National Health and Nutrition Examination Survey (NHANES). This is sent to a random representative sample of US adults every 2 years. They used data collected from 5 surveys carried out from 2005 to 2006 and 2013 to 2014.
The survey included questions about all the prescription medicines taken over the previous 30 days, and a questionnaire to assess depression symptoms. After excluding people with missing data, researchers had results from 26,192 people.
They then checked to see:
- how many people were taking 0, 1, 2 or 3 drugs associated with depression as a possible side effect
- for each of these groups, how many people had depression
Researchers also looked at how many people were taking drugs not associated with depression, and whether that was linked to how many of them had depression. They did different analyses looking separately at people taking antidepressants, and at people with high blood pressure who were on specific drugs, as some blood pressure drugs, such as beta-blockers, are known to be linked to depression.
They adjusted their figures to take account of the following confounding factors:
- ethnic background
- marital status
- employment status
- educational achievement
- family income
- body mass index
- number of long-term conditions
What were the basic results?
In total, 37% of people surveyed had taken at least 1 prescription drug associated with depression in the previous 30 days:
- 62.8% did not use any drug associated with depression
- 21% used 1 drug associated with depression
- 8.7% used 2 drugs associated with depression
- 7.5% used 3 or more drugs associated with depression
People taking these medicines were more likely to be 65 or older, female, widowed, and have a higher number of long-term health problems.
People who took more drugs with depression as a possible side effect were more likely to have depression. After taking account of potential confounding factors, the percentage of people with depression was:
- 4.7% of people using no drugs with depression as a side effect
- 6.9% of people using 1 drug with depression as a side effect
- 9.5% of people using 2 drugs with depression as a side effect
- 15.3% of people using 3 or more drugs with depression as a side effect
However, when researchers looked at medicines not associated with depression, they found no link between the number of medications taken and depression.
The drug combinations most associated with depression included the beta-blockers metoprolol and atenolol, the proton pump inhibitor omeprazole, the pain relief drug hydrocodone, and gabapentin, a drug used to treat epilepsy as well as nerve pain.
How did the researchers interpret the results?
The researchers said their results showed that “reported use of prescription medications as a potential adverse effect was common” and that using several of these drugs “was associated with a greater likelihood of concurrent depression”.
They said the results suggest that “physicians should consider discussing these associations with their patients who are prescribed medications that have depression as a potential adverse effect”.
Reading the list of potential side effects on a medicine leaflet can be daunting, and the reports of this study may also cause alarm. The first thing to remember is that not everyone gets side effects associated with a medicine. If you are taking a medicine with depression as a side effect, but you are not depressed, there’s nothing to worry about.
Depression is a complex condition and many factors can contribute to someone becoming depressed. This includes having a long-term health condition, which makes it difficult to work out whether the condition or the medicines used to treat it are a cause of depression.
However, the study is a useful reminder that some medicines can contribute to depression, including those that are prescribed for conditions you would think had nothing to do with low mood. Examples include hormonal contraceptives, drugs to lower blood pressure, painkillers, drugs used to treat respiratory diseases such as asthma, and drugs to control stomach acid.
The study has some limitations:
all the information was from US adults
rates of prescription for depression-linked drugs may be different in the US, as well as rates of depression
the cross-sectional design of the study means we don’t know whether people started taking the drugs before becoming depressed, or afterwards
the study didn’t measure whether people had a history of past depression
Also, the study only looked at prescription medications, while some drugs linked to depression are available over-the-counter in the US.
You should not suddenly stop taking any prescribed medication as this could be potentially dangerous. If you are concerned about side effects of any medicines you are taking, whether prescribed or over-the-counter, talk to your GP or pharmacist.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
Could your medications be making you depressed?
BBC News, 13 June 2018
A third of Americans are on drugs that could make them depressed – and they probably don’t know it, new research reveals
Mail Online, 12 June 2018
Links to the science
Prevalence of Prescription Medications With Depression as a Potential Adverse Effect Among Adults in the United States
JAMA. Published online June 12 2018
Medications That Can Cause Depression
There is nothing more frustrating than when the cure is part of the problem. Because depression is prevalent in patients with physical disorders like cancer, stroke, and heart disease, medications often interact with each other, complicating treatment. To appropriately manage depression, you and your physician need to evaluate all medications involved and make sure they aren’t cancelling each other out.
A review in the journal Dialogues in Clinical Neuroscience a while back highlighted certain medications that can cause depression. The following are medications to watch out for.
Medications to Treat Seizures and Parkinson’s Disease
Many anticonvulsants have been linked with depression, but three medications — barbiturates, vigabatrin, and topiramate — are especially guilty. Because they work on the GABA neurotransmitter system, they tend to produce fatigue, sedation, and depressed moods. Other anticonvulsants, including tiagabine, zonisamide, levetiracetam, and felbamate have been associated in placebo-controlled trials with depressive symptoms in patients. Patients at high risk for depression should be monitored closely when prescribed barbiturates, vigabatrin, or topiramate. When treating Parkinson’s disease, caution should be taken when using levodopa or amantadine, as they may increase depressive symptoms.
Medications to Treat Migraines
In migraine patients at risk for depression, topiramate and flunarizine should be avoided when possible. A better option is acute treatment with serotonin agonists and prophylactic treatment with TCAs, as those medications could simultaneously address symptoms of both depression and migraine headaches.
Certain headache medications like Excedrin that list caffeine as an ingredient can also worsen anxiety.
The link between blood pressure medications and depression has been well established. By affecting the central nervous system, methyldopa, clonidine, and reserpine may aggravate or even cause depression. Beta-blockers like atenolol and propranolol may also have depression side effects.
Although low cholesterol has been associated with depression and suicide, there is no clear link between depression and lipid-lowering agents.
Antibiotic and Cold Medications
Although most antibiotics used to treat infections are unlikely to cause depression, there have been some cases in which they induce symptoms. Anti-infective agents, such as cycloserine, ethionamide, metronidazole, and quinolones, have been linked to depression.
Over-the-counter cold medications like Sudafed that contain the decongestant pseudo-ephedrine can contribute to anxiety.
Antidepressants and Anti-Anxiety Medication
Sometimes medications to treat depression and anxiety can have a reverse effect, especially in the first few weeks of treatment. There have been reports of Lexapro, for example, worsening anxiety, however it usually subsides after the first few weeks. Anecdotal evidence suggests that Wellbutrin may also cause anxiety.
Approximately 10 to 25 percent of cancer patients develop significant depressive symptoms, however, given that so many medications are involved in treating cancer, it can been difficult to pinpoint the culprits. Vinca alkaloids (vincristine and vinblastine) inhibit the release of dopamine-ß-hyroxylase, and have been linked to irritability and depression. The cancer drugs procarbazine, cycloserine, and tamoxifen are also considered to induce depression.
One report cited depression in 16 percent of carmustine-treated patients, and 23 percent in those receiving busulfan when employed as part of the treatment for stem cell transplants. The antimetabolites pemetrexed and fludarabine have been reported to cause mood disturbances. Some hormonal agents to treat breast cancer have also been associated with depression, including tamoxifen and anastrozole. Finally, taxane drugs such as paclitaxel and docetaxel have been linked to depression.
Oral Contraceptives and Infertility Medications
Oral contraceptive medications have long been associated with depression. In a study published in the British Medical Journal, of the group of women taking oral contraceptives, 6.6 percent were more severely depressed than the control group. GnRH agonists (such as leuprolide and goserelin) can have depression side-effects in some people. In one study, 22 percent of leuprolide-treated patients and 54 percent of goserelin-treated patients suffered from significant depressive symptoms. Clomiphene citrate, a selective estrogen receptor modulator used to induce ovulation, has also been associated with depressed mood.
Medications That Can Cause Depression
Antidepressants and murder: case not closed
The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed: “Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt” … “All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants” (1).
Such daily monitoring is, however, a fake fix. People cannot be monitored every minute and many have committed SSRI-induced suicide or homicide within a few hours after everyone thought they were perfectly okay.
As the published trial literature related to suicidality and aggression on antidepressants is unreliable, we looked at 64,381 pages of clinical study reports (70 trials) we got from the European Medicines Agency. We showed for the first time that SSRIs in comparison with placebo increase aggression in children and adolescents, odds ratio 2.79 (95% CI 1.62 to 4.81) (2). This is an important finding considering the many school shootings where the killers were on SSRIs.
In a systematic review of placebo-controlled trials in adult healthy volunteers, we showed that antidepressants double the occurrence of events that the FDA has defined as possible precursors to suicide and violence, odds ratio 1.85 (95% CI 1.11 to 3.08)(3). The number needed to treat to harm one healthy adult person was only 16 (95% CI 8 to 100).
Based on the clinical study reports, we showed that adverse effects that increase the risk of suicide and violence were 4-5 times more common with duloxetine than with placebo in trials in middle-aged women with stress urinary incontinence (4). There were also more women on duloxetine who experienced a core or potential psychotic event, relative risk RR 2.25 (95% CI 1.06 to 4.81). The number needed to harm was only seven. It would have been quite impossible to demonstrate how dangerous duloxetine is, if we had only had access to published research. In accordance with our findings, the FDA has previously announced that women who were treated with duloxetine for incontinence in the open-label extension phase of the clinical studies had 2.6 times more suicide attempts than other women of the same age (5).
Looking at precursor events to suicide and violence is just like looking at prognostic factors for heart disease. We say that increased cholesterol, smoking and inactivity increase the risk of heart attacks and heart deaths and therefore recommend people to do something about it. Psychiatric leaders, however, routinely try to get away with untenable arguments. Many say, for example, that antidepressants can be given safely to children arguing that there were no more suicides in the trials, only more suicidal events, as if there was no relation between the two, although we all know that a suicide starts with suicidal thoughts, followed by preparations and one or more attempts. The same can be said about homicide. It can no longer be doubted that antidepressants are dangerous and can cause suicide and homicide at any age (5-7). It is absurd to use drugs for depression that increase the risk of suicide and homicide when we know that cognitive behavioural therapy can halve the risk of suicide in patients who have been admitted after a suicide attempt (8) and when psychotherapy does not increase the risk of murder.
1. FDA. Antidepressant use in children, adolescents, and adults. http://wayback.archive-it.org/7993/20170111122946/http://www.fda.gov/Dru…
2. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.
3. Bielefeldt AØ, Danborg PB, Gøtzsche PC. Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers. J R Soc Med 2016;109:381-392.
4. Maund E, Guski LS, Gøtzsche PC. Considering benefits and harms of duloxetine for treatment of stress urinary incontinence: a meta-analysis of clinical study reports. CMAJ 2017;189:E194-203.
5. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.
6. Healy D. Let them eat Prozac. New York: New York University Press; 2004.
7. Breggin P. Medication madness. New York: St. Martin’s Griffin; 2008.
8. Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med 2017 (in press).
The Relationship Between Antidepressant Initiation and Suicide Risk
There has been much debate about whether certain classes of medications (eg, antidepressants) increase the risk of suicidal behavior and whether that risk is greater in children, adolescents, and young adults. In 2004, the FDA placed a black box warning on all antidepressants because of concerns that the medications increase risk of suicidal thoughts and behavior in youths; in 2006, the warning was extended to include young adults (up to age 26). The FDA based its black box warning on results of its meta-analyses of randomized controlled trials (RCTs) conducted in pediatric and adult psychiatric and nonpsychiatric populations.
Questions regarding a possible relationship between antidepressants and suicide were first raised in 1990 with the publication of a series of case reports in which the then newly introduced SSRIs were associated with the apparent emergence of suicidal thoughts and behavior.1 This led to FDA hearings in 1991, but no evidence of an increased risk of suicidal acts associated with antidepressants was found. In October 2004, concerns raised over paroxetine use in children and adolescents eventually led the FDA to issue a black box warning regarding antidepressants and suicide for children younger than 18 years.
The evidence supporting the first black box warning came from a meta-analysis that combined spontaneous reports of suicidal thoughts and behaviors from pediatric RCTs of newer antidepressants, mostly SSRIs.2 The risk of suicidal ideation and behavior, or suicidality, was found to be higher for children treated with antidepressants than for those given placebo (odds ratio = 1.78; 95% confidence interval , 1.14, 2.77). The FDA also presented results of an analysis of prospective data (suicidal ideation or behavior rating-scale item) that showed no effect for emergence (OR: 0.93; 95% CI: 0.75, 1.15) or emergence and/or worsening of suicidal thoughts and behavior in the active-drug group compared with the placebo group (OR = 0.92; 95% CI, 0.76, 1.11).
The inconsistency between the prospective clinician ratings and spontaneous patient reports has not been adequately explained. It may be due to bias because patients randomized to active drug treatment have a greater likelihood of adverse effects in general, leading to more contact or conversation with study staff and increased chance of having any suicidal thoughts observed. Similarly, overdose on study medication is more likely to be reported if it results in the need for medical attention, as would be true for patients who receive active treatment rather than placebo.
Systematic questioning in a setting such as the emergency department or inpatient service generally gives a more accurate rate of suicidal ideation and behavior than do spontaneous reports. The FDA based its decision on the “signal” of risk from spontaneous adverse-event reports and not on the absence of a signal of risk from systematic clinician evaluations.
In January 2006, the FDA conducted a second meta-analysis of 372 RCTs of newer antidepressants in an adult population of approximately 100,000 patients.3 This analysis was based on spontaneous adverse-event reports from the RCTs and did not provide data from prospective clinician ratings. Overall, the analysis revealed no evidence of more suicide-related adverse reports in the antidepressant group than in the placebo group. Stratification by age showed that for the primary endpoint of suicidal ideation or behavior, for 18- to 24-year-olds, the risk was increased with medication compared with placebo, and the risk approached significance (OR = 1.62; 95% CI, 0.97, 2.71); for adults aged 25 to 64 years, the risk was significantly decreased (OR = 0.79; 95% CI, 0.64, 0.98); and for geriatric patients, the risk was markedly decreased (OR = 0.37; 95% CI, 0.18, 0.76) with antidepressants relative to placebo. On the basis of these results, the FDA extended the black box warning to cover 18- to 24-year-olds.
More recent data
Since the FDA warnings, studies have been conducted to explore the relationship between initiation of antidepressant treatment and suicidal events. We review several lines of evidence that range from the weakest data based on spontaneous reports to the most rigorous data based on RCTs.
Spontaneous reports. Spontaneous reports to the FDA can be made by anyone; most are from patients, physicians, pharmaceutical companies, and plaintiff attorneys. They report both an adverse event and a listing of one or more medications that a patient is taking at the time of the event. Use of the spontaneous reporting systems for drug safety determination is highly problematic. Some limitations regarding these data are:
• Confounding by indication (ie, patients taking a particular drug may have a disease that is itself associated with a higher incidence of the adverse event)
• Systematic underreporting
• Effects of publicity in the media on numbers of reports
• Duplication of reports
• Attribution of the event to a single drug when patients may be taking multiple drugs
• Missing data
These limitations degrade the capacity for optimal data mining and analysis, and any conclusions must be tentative and require validation by another data source.4
Prescription Drugs That Cause Depression
What do certain asthma, acne, malaria, and smoking-cessation prescription drugs have in common? Answer: Their possible side effects include depression or other mood disorders.
Depression as a side effect of prescription drugs is widespread and increasingly gaining attention. The medications that contribute to drug-induced depression might surprise you. For example, an asthma medication, Singulair (montelukast), is prescribed to help people breathe more easily, but its side effects may include depression, anxiety, and suicidal thinking, according to a research review published in Pharmacology in 2014.
“In 2009, Merck added psychiatric side effects as possible outcomes with Singulair, including tremor, depression, suicidality — suicidal thinking and behavior — and anxiousness,” says J. Douglas Bremner, MD, researcher and professor of psychiatry and radiology at Emory University School of Medicine in Atlanta.
Drugs With Depression as a Side Effect
Dr. Bremner has published studies on the possible relationship between the use of retinoic acid acne treatments and the development of depression. One of the drugs within this category is Accutane (isotretinoin), the oral treatment for severe acne that has been associated with psychiatric problems, including depression.
“The original brand-name version of isotretinoin, Accutane, was taken off the market in 2009, although it continues to be marketed as Roaccutane in the U.K., Australia, and other countries,” Bremner notes. “In the U.S. there are three generic versions available that have also been associated with reports of depression and suicide, Sotret, Claravis, and Amnesteem.”
RELATED: Are You Getting Hooked on Anxiety Medications?
The full list of drugs that could cause depression is a long one. British researchers found 110 different medications between 1998 and 2011 that were associated with increased depression risk, according to a report published in BMC Pharmacology and Toxicology in September 2014.
Besides isotretinoin and montelukast, drugs that can cause or contribute to the development of depression or other mood symptoms include:
- Lariam (mefloquine), used to treat malaria. Depression, anxiety, and psychosis are among the side effects of this medication, according to an article in Medical Science Monitor in 2013 that explored the chemical cascade behind mood changes.
- Chantix (varenicline), used to stop smoking. The Food and Drug Administration (FDA) lists hostility, anxiety, depression, and suicidal thoughts as possible side effects of this medication.
- Inderal (propranolol hydrochloride) and other drugs in the beta-blocker class, used to treat high blood pressure. Research on beta-blockers and depression suggests that some, but not all, of the medications in this class can contribute to depression, according to a report in the February 2011 issue of the Journal of Clinical Psychopharmacology.
- Contraceptives. Contraceptives including those delivered by vaginal ring or patch could lead to depression in some people, according to research published in the Cochrane Database of Systematic Reviews in 2010.
- Corticosteroids. Some people who take corticosteroids experience side effects such as depression, anxiety, and panic attacks, among other symptoms, according to a review of research published in Rheumatology International in 2013.
- Interferon-alpha. As many as 40 percent of people using this immunologic medication may experience depression, according to a 2009 report in Dialogues in Clinical Neuroscience.
- Interferon-beta. The link between this immunologic medication and depression is debated, but researchers reporting in Therapeutic Advances in Neurologic Disorders in 2011 note that depression is a concern for those who take it, in part because of their underlying conditions.
- Nonnucleoside reverse transcriptase inhibitors. These HIV medications may increase the risk for depression, according to research published in the September 2014 issue of HIV Medicine. Arimidex (anastrozole) and aromasin (exemestane). Both of these long-term breast cancer therapies may contribute to depression, according to the FDA.
- Vigabatrin. This anticonvulsant may cause depression, irritability, and psychosis, notes a review of studies in Acta Neurologica Scandinavica in 2011.
The FDA investigates drugs that have many reports of depression symptoms as a side effect. It requires what are called black-box warnings to be clearly printed on medications, like isotretinoin, that have been linked to depression and suicidal behavior, among other serious health threats. Make sure you read the information pamphlets that come with your prescription medications (and ask your pharmacist if you don’t understand what they say). You can stay on top of any news about their side effects by setting up a news alert on Google.
You can get the latest drug safety information on the FDA website.
Also, pay attention to how you feel. Though you may be taking medications that seem unrelated to mood, let your doctor know if you have symptoms such as sadness, difficulty sleeping, hopelessness, sleep changes, or thoughts of suicide.
“If you suspect your medication may be causing depression or similar problems, talk with your doctor and, if necessary, consult with a psychiatrist,” Bremner advises. The good news is that drug-induced depression usually clears up once you stop taking the medication.
Are Your Drugs Causing Depression?
It can be challenging to figure out whether your depression is related to taking a prescription drug, but here are some indicators:
- Timeline. Drug-induced depression is defined as depression that appears within a month of starting or stopping a medication, according to the American Society of Health-System Pharmacists (ASHP). The society also advises that other conditions that might cause depression have to be considered in figuring out whether medication is the contributing factor. Bremner found in his research that the timeline varies from weeks to a month or two.
- Dose-response relationship. With some drugs, depression symptoms may get better as the dose is reduced or worse as it is increased. This is usually a clear indicator of a relationship.
If you are uncertain about whether your changes in mood or energy are drug symptoms, talk with your doctor. Screening tools and questionnaires can reliably identify depression. You can also send information about your experiences to the FDA.
Prescription Drug-Induced Depression Treatment
In severe cases, people taking prescription drugs have developed depression leading to suicidal behavior. Because of this risk, don’t ignore or try to wait out feelings of depression, even if you believe they are only a prescription drug side effect. Talk with your doctor about these options to correct the situation:
- Switching to an alternative treatment. If an equally effective medication that does not have depression as a side effect exists, the easiest option is to switch prescription drugs.
- Getting a psychiatric evaluation. This may be recommended in any case to make sure you do not have an underlying psychiatric condition that has gone undiagnosed. People with a history of depression may have a worse response to some medications. An antidepressant might be prescribed in order to help manage depression symptoms.
Talk therapy will not work in this case, says Bremner, because the problem is chemically based. You will need prescription medication to address the depression if you cannot stop taking the drugs that are causing it.
If you think your depression symptoms are linked to a prescription drug you’re taking, talk with your doctor right away, get screened for depression, and find a better way to manage both your health issues and your mood.
37% of US Adults Are Using Common Meds They Don’t Realise Could Cause Depression
Most prescription medications come with such a long list of potential side-effects that many patients may have no idea what they are getting themselves into.
But when the potential consequences include depression and suicide, ignorance is decidedly not bliss.
A new study has found that between 2005 and 2014, 37.2 percent of US adults may have been unknowingly using common medications that can cause depression as a side-effect.
“Many may be surprised to learn that their medications, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms, and may lead to a depression diagnosis,” said lead author Dima Qato, an assistant professor at the University of Illinois.
The National Health and Nutrition Examination Survey examined more than 26,000 Americans over the age of 18, excluding those who already use antidepressants.
The findings revealed that more than 200 commonly used prescription drugs list depression or even suicide as potential consequences. These popular medications include drugs like hormonal birth control medication, blood pressure medication, antacids and painkillers.
Many of these medications are available over the counter and their warning labels do not list comprehensive information on their potential adverse effects.
As a result, the researchers state that “many patients may therefore not be aware of the greater likelihood of concurrent depression associated with these commonly used medications.”
To make matters worse, when these drugs are used together (called polypharmacy), they can exacerbate the prevalence of depression.
The survey found about 15 percent of the people who used three or more of these drugs experienced depression – a big jump from the 7 percent that used only one medication, and the 9 percent that used two medications.
In comparison, only 5 percent of those surveyed experienced depression without taking any drugs, roughly three times fewer than those taking three medications.
The same sort of pattern was observed for medications that can cause suicidal ideations.
“The take away message of this study is that polypharmacy can lead to depressive symptoms and that patients and health care providers need to be aware of the risk of depression that comes with all kinds of common prescription drugs – many of which are also available over the counter,” said Qato.
The need for awareness on this issue is vital, especially as polypharmacy becomes more popular. The study found that between 2005 and 2015, American patients taking more than one of these drugs jumped from 7 to 10 percent.
Nevertheless, a worrying number of patients and medical professionals have no idea about the risks that polypharmacy holds. Right now, typical depression screening tests do not take into account prescription medications that list depression as a possible side effect.
“People are not only increasingly using these medicines alone, but are increasingly using them simultaneously, yet very few of these drugs have warning labels, so until we have public or system-level solutions, it is left up to patients and health care professionals to be aware of the risks,” Qato said.
The issue is even more pressing given that depression and suicidal side-effects are showing up more and more in pharmaceuticals.
The study found that depression side-effects increased by 35 percent in prescription medications between 2005 to 2006. From 2013 to 2014, that number went up to 38 percent.
When it comes to prescription drugs listing suicide as a side-effect, the numbers are even more worrisome, jumping from 17 to 24 percent over the same period.
At the same time, it is becoming more common to use multitudes of these drugs. The study found that the use of three or more drugs with suicidal side-effects has increased from two to three percent.
The new study comes shortly after a recent report by the Centers for Disease Control (CDC) that found a shocking rise in suicide rates across the US.
While it can’t be said that this is directly related to the side-effects of prescription medication, it certainly speaks to a larger issue – namely, how much more the public health system needs to focus on depression and suicide.
Qato argues that in order to solve the problem identified in his study, we need to update our drug safety software so that patients, medical professionals and pharmacists are all fully aware that taking multiple medications may increase a patient’s risk of developing depression or suicide.
“With depression as one of the leading causes of disability and increasing national suicide rates, we need to think innovatively about depression as a public health issue,” Qato said.
“This study provides evidence that patterns of medication use should be considered in strategies that seek to eliminate, reduce or minimise the impact of depression in our daily lives.”
The results have been published in Journal of the American Medical Association.
If this story has raised concerns or you need to talk to someone, here’s a list where you may be able to find a crisis hotline in your country.
“Depression is a serious medical condition that can develop based on any number of factors,” Samar McCutcheon, M.D., a clinical assistant professor of psychiatry at the Ohio State University Wexner Medical Center, tells SELF. Factors like going through a traumatic event, having a family history of depression, or having a serious or chronic illness may increase your risk for depression alongside taking certain medications, the Mayo Clinic says.
Based on the study’s findings and the fact that depression is so complex, “it’s not possible to say with certainty” that these medications were the only reason why some people developed depression, Dr. McCutcheon says. Even Qato says that her work doesn’t show a cause and effect relationship: “This study doesn’t prove that taking medications with depression as a side effect causes depression,” she explains. “It demonstrates that there is an association between the number of medications used with depression or suicidal symptoms as an adverse effect and depressive symptoms.”
The way a side effect gets listed on a medication is a little convoluted.
A drug has to undergo several clinical trials before the Food and Drug Administration (FDA) approves it, as the FDA website explains. During those trials, drug makers will look for any side effects that people experience and report those to the FDA, Dr. Alan says.
According to regulations, a company must display the most frequent side effects of a prescription medication in its labelling in decreasing order of frequency, FDA spokesperson Lyndsay Meyer tells SELF. Additionally, any adverse reactions included in the labeling are limited to those “for which there is some basis to believe there is a causal relationship between occurrence of an adverse event and the use of a drug,” Meyer says.
But, “the tendency for companies is to make a really inclusive side effect list for legal reasons,” Dr. Alan says. So, a drug company may add depression as a potential side effect to the label even if only a small percentage of people who used the drug developed depression while they were taking the drug, which may or may not have been related to the medication itself, just so there aren’t any surprises.
Once a drug goes on the market, it will continue to be monitored via post-market surveillance, and people who take the drug can report any side effects directly to the FDA. Still, “it’s hard to wade through what’s concerning and what’s not concerning,” Dr. Alan says.
What doctors do know is that, if you’re taking multiple drugs with similar side effects, your chances of developing that side effect increase, as this recent study found.
If you’re taking a medication that lists depression as a potential side effect, it’s important to at least be aware of that—especially if you already have other risk factors for depression.
To find out if your drug is linked to an increased risk of depression, take a look at the pamphlet that came with it. Or, if you tossed that a while ago, look up the drug’s website—many list potential side effects on the homepage.
If you’re taking one of the drugs included in this study, it’s also good to have an understanding of the symptoms of depression, Igor Galynker, M.D., associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel, tells SELF. That includes a persistent feeling of sadness; feelings of hopelessness, guilt, worthlessness, and helplessness; a loss of interest in doing things; fatigue; difficulty concentrating; insomnia; low appetite; restlessness or irritability; unexplained aches and pains; and thoughts of death or suicide, according to the National Institute of Mental Health.
However, as Dr. Galynker points out, it can be difficult to notice a pattern of changes in your mood. Plus, it can take weeks for mood changes to actually happen after you start taking a medication, he says, making it even more challenging to connect the dots.
If you notice that you’re having signs of depression and you recently started taking a new medication, talk to your doctor, Dr. Olfson recommends. They’ll help determine whether or not your medication may be impacting your mood and can recommend an alternative. If you have a history of depression, definitely ask your doctor about potential side effects of new medication when it’s prescribed so it is at least on your radar, Dr. Galynker says.
And again, don’t hesitate to ask for help if you need it. “This doesn’t make you weak,” Dr. Alan says. “Let us help you.”
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