A recent US study has revealed a worrying trend: in the midst of growing concerns about rising rates of depression, nearly 40% of adults are taking prescription drugs that can cause depression as a ‘side effect’, and the number of people taking such drugs is steadily increasing.
The study, conducted by researchers at the University of Illinois, Chicago, and Columbia University, New York, used data from over 26 000 participants in the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional (i.e. conducted at one point in time) survey of the community-dwelling US population, which is conducted in 2-year cycles.
NHANES collects data on use of prescription medications, as well as using the Patient Health Questionnaire 9 (PHQ-9) to screen participants for depression.
The researchers used a database called Micromedex to identify prescription medications with depression, depressive disorder, suicide, suicidal thoughts, suicidal ideation, or suicidal behaviour listed as common or serious adverse effects. There are over 200 medications with these adverse effects – including antidepressants, which in the US are dispensed with a black-box warning for suicidal risk.
Other commonly used medications that have depression as a potential adverse effect are antihypertensives (blood pressure-lowering medications), proton pump inhibitors (acid suppressors such as Nexium and Somac), analgesics (pain relieving medications), and hormonal contraceptives (“the Pill”).
The researchers then combed through NHANES data to calculate the likelihood of depression in adults who were taking one or more of these drugs, compared to the likelihood in adults who weren’t taking any drugs that can cause depression.
They found that 37.2% of adults had used at least 1 prescription drug with the potential to cause depression in the last 30 days. Participants who were aged over 65 years, female, widowed, and/or suffering from a higher number of chronic health conditions were more likely to be using such drugs.
Worryingly, the prescription of medications with the potential to impair people’s mental health is steadily rising:
- Use of any prescription medication with depression as a potential adverse effect rose from 35% of participants in NHANES 2005-2006, to 38.4% in 2013-2014.
- Use of 3 or more drugs that can cause depression at the same time increased from 6.9% in 2005-2006 to 9.5% in 2013-2014.
- Use of any prescription medications that have suicidal symptoms as potential adverse effects increased from 17.3% in 2005-2006 to 23.5% in 2013-2014.
- Concurrent use of 3 or more prescription medications that can cause suicidal symptoms increased from 1.9% in 2005-2006 to 3.3% in 2013-2014.
7.6% of participants aged over 18 reported depression during the study period. However, the prevalence of depression varied significantly by medication use:
- 4.7% of participants who were not taking any medications with depression as a potential adverse effect reported depression.
- 6.9% taking 1 such drug were depressed.
- 15.3% of participants taking 3 or more of these drugs were depressed.
- Compared to adults who were not using any medications that have suicidal symptoms as potential adverse effects, those take 1 drug that can cause this effect were 3.1% more likely to report depression, those taking 2 such drugs were 7% more likely, and those taking 3 or more such drugs were 12.5% more likely.
As the authors summarised,
“The likelihood of concurrent depression was most pronounced among adults concurrently using 3 or more medications with depression as a potential adverse effect, including among adults treated with antidepressants.”
On the other hand, adults who were taking 3 or more medications without depression as an adverse effect were no more likely to be depressed than those taking no prescription drugs.
The most common combination of depression-inducing drugs involved the β-blockers metoprolol or atenolol, the proton pump inhibitor omeprazole, the narcotic hydrocodone, and the anticonvulsant gabapentin.
However, the drug combination most strongly associated with depression was gabapentin plus cyclobenzaprine (a muscle relaxant) – nearly 61% of adults who were taking these drugs concurrently reported depression.
To make sure that they weren’t confusing cause with effect – that is, the possibility that people who are already depressed may take more prescription drugs – the researchers reanalysed their data after excluding participants who were taking any kind of psychiatric medication… and found the same effect. Among adults who were concurrently using 3 or more non-psychotropic medications that have depression listed as an adverse effect, 8.5% reported that they were depressed vs 4.5% of adults who were not taking any such medications.
As concerning as it is that commonly-prescribed drugs and drug combinations are associated with an increased the risk of depression, the researchers point out that the true impact of pharmaceutical drugs on mental health is probably even greater than they report, because one of the most widely-used drug classes with depression as an adverse effect is proton pump inhibitors, many of which are available without a prescription.
The growing awareness of high rates of undiagnosed and untreated depression in the community has led to recommendations for primary care providers, such as GPs, to screen patients for depression. As I discussed in my article Who says you’re depressed or anxious? Pfizer does, the most commonly-used screening tool for depression was developed by a drug company which manufactures several of the most widely-prescribed antidepressant drugs on the market.
Aside from the conflict of interest inherent in a drug company developing a screening tool to identify potential customers for its product, the authors of this study point out that
“Commonly used depression screening instruments… do not incorporate evaluations of prescribed medications that have depression as a potential adverse effect.”
So, rather than your GP asking whether you’ve been feeling unusually tired, persistently sad, and disinterested in activities that you used to enjoy, and then going through your current list of prescriptions to check whether anything you’re taking could be causing these symptoms, he or she is far more likely to prescribe an antidepressant (which could cause you to spiral downwards from ‘merely’ depressed to suicidal), or refer you to a psychiatrist who will do exactly the same thing.
Sadly, your doctor may not even be aware that depression is a potential side effect of medications you’ve been prescribed, and if the pharmacist doesn’t include the prescribing information when dispensing your drugs, the only way you could find out if something you’re taking is contributing to your depression is to find the full prescribing information online.
If you’re prescribed an antidepressant rather than being ‘deprescribed’ the drug/s that are lowering your mood, not only has the underlying cause of your depression – or at the very least, a significant contributing factor to it – gone completely unaddressed, you will also more than likely end up taking a drug that does not relieve mild to moderate depression any better than a placebo (an inactive ‘dummy’ medication) and offers a clinically insignificant benefit over placebo in major depressive disorder.
The bottom line is that if you’re on a medication capable of causing depression, such as a proton pump inhibitor or antihypertensive, your best bet is to overhaul your diet and lifestyle to remove the cause of your reflux or high blood pressure.
Ditto if you’re feeling depressed. The ‘biochemical imbalance’ theory of depression is nonsense, abandoned for lack of proof by depression researchers decades ago, yet it continues to be promoted to patients to this day. Aside from switching to medications that don’t have the potential to cause depression – or better yet, making diet and lifestyle changes that render them redundant – addressing the other drivers of depression, such as unhealthy eating patterns, lack of sleep and exercise, and dysfunctional thinking patterns, offers the best hope for overcoming depression.
See my articles 5 reasons to think twice before taking antidepressants, Depression: Bringing your black dog to heel, Good mood food, and Want to feel happier? Change what’s on your plate! for more information on depression and how to address it.
Need personalised help to locate and address the causes of your depression? Apply for a Roadmap to Optimal Health Consultation today.
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