Rising rate of depression due to Adverse effect of common drugs : JAMA

Use of common drugs with depression as a possible side effect is increasing — and the more of these drugs patients take, the greater their likelihood of depression — a JAMA study finds.

The study by Chicago researchers suggests that more than one-third of U.S. adults may be using prescription medications that have the potential to cause depression or increase the risk of suicide and that because these medications are common and often have nothing to do with depression, patients and health care providers may be unaware of the risk.

The researchers used data from 26,000 adults who participated in the National Health and Nutrition Examination Survey between 2005 and 2014.They found that more than 200 commonly used prescription drugs — including hormonal birth control medications, blood pressure and heart medications, proton pump inhibitors, antacids and painkillers — have depression or suicide listed as potential side effects. Roughly 37% said that within the past 30 days, they had used at least one medication that listed depression as a possible side effect (for example, proton pump inhibitors). That proportion increased over time.

The researchers observed similar results for drugs that listed suicide as a potential side effect. These findings persisted when the researchers excluded anyone using psychotropic medications, considered an indicator of underlying depression unrelated to medication use.

"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 lead author Dima Qato, assistant professor of pharmacy systems, outcomes and policy in the UIC College of Pharmacy. "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."

The prevalence of depression was 5% for people who didn't take any of these drugs, 7% for those taking one of these drugs, and 15% for those taking three or more. Strikingly, the depression prevalence was 61% among that co-prescribed gabapentin and cyclobenzaprine.

The authors concluded: "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."

The lead author Qato says that solutions worth further study may include updating drug safety software to recognize depression as a potential drug-drug interaction, so that healthcare professionals, including pharmacists, are more likely to notice if a patient is using multiple medications that may increase risk.