Jun. 19 2018

One-Third of U.S. Adults May Unknowingly Use Medications That Can Cause Depression

A study co-authored by Mark Olfson, MD, MPH, professor of Epidemiology at Columbia University’s Mailman School of Public Health, and colleagues from the University of Illinois at Chicago 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. Because these medications are common and often are prescribed for conditions that have nothing to do with depression, patients and healthcare providers may be unaware of the risk. The findings are published online in JAMA.

[Read a Q&A with Olfson about the study.]

The researchers retrospectively analyzed medication use patterns of more than 26,000 adults from 2005 to 2014, which were collected as part of the National Health and Nutrition Examination Survey. They found that more than 200 commonly used prescription drugs—hormonal birth control medications, blood pressure and heart medications, proton pump inhibitors, antacids, and painkillers—have depression or suicide listed as potential side effects.

The study is the first to demonstrate that these drugs were often used concurrently and that concurrent usepolypharmacywas associated with a greater likelihood of experiencing depression. Approximately 15 percent of adults who simultaneously used three or more of these medications experienced depression while taking the drugs, compared with just 5 percent for those not using any of the drugs, 7 percent for those using one medication, and 9 percent for those taking two drugs simultaneously.

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 drugsmany of which are also available over the counter,” says lead author Dima Qato, assistant professor of pharmacy systems, outcomes and policy in the University of Illinois at Chicago 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.”

According to Olfson who is also a professor of Psychiatry at Columbia University Irving Medical Center and senior author, the study also shows an important trend of increasing polypharmacy for medications with depression, particularly suicidal symptoms, as a potential adverse effect. “This makes the need for awareness of depression as a potential adverse effect even more pressing,” he says.

The researchers found use of any prescription medication with a potential depression adverse effect increased from 35 percent in the 2005 to 2006 period to 38 percent in the 2013 to 2014 period. Approximate use of antacids with potential depression adverse effects, like proton pump inhibitors and H2 antagonists, increased from 5 percent to 10 percent in the same period. Use of three or more drugs concurrently increased from 7 percent to 10 percent, approximately.

For prescription drugs with suicide listed as a potential side effect, usage increased from 17 percent to 24 percent, and use of three or more drugs concurrently increased from 2 percent to 3 percent. These medicines are not only increasingly being used alone, but are being taken simultaneously, yet very few of these drugs have warning labels, so until there are public or system-level solutions, it is left up to patients and healthcare professionals to be aware of the risks.

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, note the research team.

“Depression is one of the leading causes of disability and increasing national suicide rates, and we need to think innovatively about depression as a public health issue,” says Olfson. “This study provides evidence that patterns of medication use should be considered in strategies that seek to eliminate, reduce or minimize the impact of depression in our daily lives.

Katharine Ozenberger of UIC is also a co-author.