Worried about depression? Check the side effects of your prescriptions

Milwaukee Journal Sentinel

Americans interested in protecting their mental health may need to look no further than their medicine cabinet.

Research out last week found that one in three Americans is taking prescription medication with depressive side effects. Taking three or more of these medications triples the odds of experiencing depression. Most people aren’t aware of these risks.

Prescription drugs with depressive side effects are more prevalent than previously expected, reports a new study out this week.

The research, published in the Journal of the American Medical Association, used data from over 26,000 Americans and controlled for gender, age, income, chronic health conditions and many other factors already suspected to increase susceptibility to depression.

The scientists report that 37.2% of Americans are currently taking at least one prescription with depressive side effects. The most common prescriptions were those taken for depression (15% of the population), heartburn/acid reflux (10%), hypertension (8%), hormonal birth control (7%), anxiety and insomnia (7%) and pain relief (7%).

"I was surprised that so many drugs have depression as a side effect," said Dima Qato, assistant professor of pharmacy systems, outcomes and policy at the University of Illinois-Chicago, who led the study. "It was just an indicator that, wow, I'm sure people are not aware of this."

The subject is front and center these days because of two recent celebrity suicides —Kate Spade and Anthony Bourdain — and concerns that depression and suicide are dramatically rising.

Taking just one of these medications slightly increased prevalence of depression from 5% to 7%, but depression prevalence increased to 15% for those taking three or more medications with depression as a potential side effect. Patients taking multiple medications that did not have these side effects did not show any increases in depression.

These numbers are even higher when considering medications with “suicidal symptoms” listed as a potential adverse effect, with 8% of people on one of these medications reporting depression and 18% of people taking three or more reporting depression.

Certain combinations of drugs were worse than others, with gabapentin plus cyclobenzaprine topping the list with 61% of dual users reporting depression. For adults currently treated with antidepressants, those taking just one or more additional medications with these side effects were more likely to report continued depressive symptoms.

Though this study only examined use of prescriptions, many drugs that made the list are also common over-the-counter purchases, like ibuprofen (Advil), omeprazole (Prilosec), and cetirizine (Zyrtec). If these had been included in the study, Qato said, the results would have been even more dramatic.

Most patients are aware that prescription drugs can have unintended side effects, but the lists of possibilities rattled off on TV commercials or shoved into paper bags by pharmacists are often ignored.

Researchers and health care professionals are urging patients to pay attention to their prescriptions' listed side effects and reach out to their health care providers if they begin to experience symptoms of depression.

“Depression is so multifaceted, and there’s likely not just one cause for everyone,” said Casey Gallimore, assistant professor of pharmacy at the University of Wisconsin-Madison. “It’s a very good reminder that as health care clinicians, part of our job is to understand the risks of medication use.”

But don't ditch your prescriptions just yet.

"I don’t want patients to stop taking their drugs because of this study," Qato said. "I want physicians and pharmacists to be aware of this rise in suicide and burden of depression in the country. We really need to think about how medication is playing into this. The use of many medications together is quite prevalent in adults."

Gallimore agrees, and recommends having a conversation with your health care provider about weighing risks and benefits.

“The lists of side effects are endless — we can do a better job of knowing which side effects are more likely to occur, and get that information to patients,” she said. “It’s a balance. … I don’t want to scare someone into not considering taking a medication that could have life-saving effects.”