Medications are supposed to make you feel better – and most of the time they do. But they also often come with side effects. Usually, those unwanted consequences are minor, but in some cases, they can be serious. Some drugs can even cause depression, regardless of whether or not you’re predisposed to mental health problems. What’s even more worrisome is that consumers and health care providers may be unaware of this hidden risk. According to a study published today in JAMA, more than one-third of adults may be using prescription medications that have the potential to cause depression or increase the risk of suicide. As part of the study, researchers found that more than 200 commonly used drugs have depression or suicide listed as potential side effects. But because many of these drugs—including hormonal contraceptives, blood pressure and heart medications, antacids, and painkillers—are prescribed for purposes unrelated to mental health, they worry that patients may never be warned about the increased risk.
No one knows exactly why certain drugs have this effect. “The medications may interfere with neurotransmitters in your brain like dopamine and serotonin, [and that] may affect mood changes,” says Edmi Cortes, MD, assistant professor of clinical psychiatry at the University of Miami Miller School of Medicine, who was not involved in the new study. That may be especially true when patients are prescribed more than one drug—which, according to the new JAMA study, is happening more often than it used to. Researchers looked at medical records of more than 26,000 patients over a 10-year period, studying their use of those 200+ drugs with potential mood-altering side effects. About 15% of adults who used three or more medications at the same time experienced depression, compared with 9% of those who took two, 7% who took one, and just 5% who took none. The researchers saw a similar pattern for drugs that listed suicide as a potential side effect. And those patterns remained, even after they excluded patients who were also taking medications prescribed for pre-existing anxiety or depression.
If you suspect you’ve developed depression as the result of a medication, contact your doctor right away. “The most important thing is to communicate with your doctor when you experience mood changes,” says Dr Cortes. “We can manage by reducing the dosing, by changing the medication or, when the medication is really necessary to treat the illness, by giving an antidepressant to treat depressive symptoms.” Here are some commonly used drugs that are sometimes linked with depression. Talk to your doctor if you’re taking one of these and notice changes in your mood.
Beta blockers such as metoprolol are widely prescribed to treat high blood pressure, but they’re also used for chest pain, irregular heartbeat, migraine, some tremors, and even glaucoma. Generally, and especially for hypertension, beta blockers are used long-term, but some research has linked continued use with depression. The good news is there are tons of alternatives; in fact, beta blockers aren’t even used that often any more. “They’ve gone a little out of favour as a standard treatment because there are newer things that may work better without [the risk of depression],” says Joshua Nathan, MD, president-elect of the Illinois Psychiatric Society and assistant professor of clinical psychiatry at the University of Illinois Chicago.
Steroids like prednisone are used to treat a surprising number of conditions, including autoimmune diseases like rheumatoid arthritis and lupus, asthma, allergies, and even cancer. But they can come with a mental health downside. “Chronic use is associated with a range of psychiatric problems,” says Dr Nathan. “It can cause depression, anxiety, psychosis–and I’ve seen all of those things.” Euphoria and mania seem to be more common with short-term use while depression becomes more prominent with longer use, even if the doses aren’t large. If you have a family history of depression or alcoholism, you have an even greater risk for developing one of these side effects when using corticosteroids. Talk to your doctor or specialist about your risk factors and medication alternatives.
Not all antibiotics, of course, but certainly some have been linked with depression, notably levofloxacin and ciprofloxacin. Both belong to the family of antibiotics known as fluoroquinolones and are prescribed for a variety of bacterial infections. A large survey of medical records in the United Kingdom found that just one course of quinolones was linked with a 25% higher risk of depression. Also, taking one course of med in the penicillin group of antibiotics was associated with a 23% higher risk of depression. Two courses of penicillin took the risk up to 40%, and more than five courses involved a 56% higher risk. Make sure you only take antibiotics when you need them. Overuse also contributes to the spread of antibiotic-resistant bacteria.
As many as 40% of people being treated with interferon develop depression. The drug is used in the treatment of some cancers and viral infections, like hepatitis C, among other things. The depression usually goes away once the treatment has ended, but one study found that it could come back later. Given that interferon combats life-threatening illnesses, antidepressants are sometimes used so the person can continue the treatment. Research has shown that selective serotonin reuptake inhibitors (SSRIs) and other classes of antidepressants can bring relief to up to 85% of people who develop depression during interferon treatment.
Some reports have indicated that anticonvulsant (or anti-seizure) drugs like topiramate and gabapentin may contribute to depression. These drugs suppress the central nervous system (CNS). “We know that medications that are central nervous system depressants may be associated with depression,” says Dr Cortes. Benzodiazepines (like common anti-anxiety meds Xanax and Valium) are also CNS depressants and have been associated with depression. Luckily, “medication-induced depression goes away when you stop the medication,” says Dr Nathan, and “there are usually other options.” Anticonvulsants are now used to treat not just seizures but also bipolar disorder, pain from damaged nerves, and fibromyalgia. There are other treatments for all of these conditions, and there are also alternatives for benzodiazepines.
The addictive painkillers–which are responsible for one of the greatest public health crises in American history–also seem to increase the risk of depression. One study found that the risk of depression in people who had never had it grew the longer they took opioids, starting at about 30 days. The dose didn’t seem to matter. At the same time, recent research has found that more than half of all opioid prescriptions in the U.S. are going to people with existing mental health conditions like depression or anxiety. People with these mood disorders are at a greater risk of abusing opioids.
Hormonal birth control
Some studies have linked popular contraceptive methods—including birth control pills, patches, vaginal rings, and hormonal IUDs — to depression or lower quality of life. Researchers say that hormonal changes triggered by these medications, such as a decrease in testosterone or an increase in progesterone, may play a role. But it’s important to take these findings with a grain of salt, experts say, and to know that birth control can affect each woman differently. A recent review published in Contraception concluded that there is no link between hormonal contraception and depression, and a study published last year in Menopause found that hormonal birth control may protect women from depression later in life. Birth control also helps regulate hormone levels, and for some women—especially those with heavy periods or conditions like endometriosis—it may reduce physical and emotional symptoms associated with menstruation every month.
Among the 200-plus medications cited in the new JAMA study are two drugs commonly prescribed to treat heartburn: antacids and proton-pump inhibitors, or PPIs. Although depression isn’t a common consequence of these drugs, some in these classes do list it as a potential side effect. Taking a proton-pump inhibitor can interfere with the body’s ability to absorb vitamin B12, an essential nutrient that produces chemicals that affect mood and cognition. PPIs have been linked to depression in at least one recent study, published in International Psychogeriatrics. Antacids, which are available with a prescription and over the counter, are generally considered safe—, but patients should still be aware of potential side effects, especially when they’re frequently taken or in large quantities.
You’ve probably seen or heard the warnings that antidepressants can increase the risk of suicidal thoughts or ideation. Strange as this may seem, research backs it up. “Teens and young adults in their early 20s in rare cases have increased in suicidal ideation when starting an antidepressant,” says Dr Nathan. “But there is no data saying that starting antidepressants can cause or worsen depression, and long-term use is not associated with depression either.” Antidepressants have helped millions of people emerge from depression; the percentage of young people experiencing suicidal thinking as a side effect is small. Talk to your doctor if you suspect your depression is getting worse on treatment or you are contemplating harming yourself. Never stop taking one of these medications without supervision from your doctor.
Credit: Amanda Gardner And Amanda MacMillan for Health, 12 June 2018.