Depression: Common medication side effect?

[Monirul Islam]

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
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.

Source: Harvard Medical School Website