A new study co-authored by Dr. Mark Olfson, professor of epidemiology at Columbia University Mailman School of Public Health, and colleagues from 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 health care providers may be unaware of the risk. The findings are published online in JAMA.
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 — 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.
The study is the first to demonstrate that these drugs were often used concurrently and that concurrent use – polypharmacy — was 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 drugs — many of which are also available over the counter,” said lead author Dr. 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 Dr. Olfson who is also 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 said.
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.