Are Drug Side Effects Driving Depression Rates?

A new study finds that more than a third of Americans are taking prescription drugs that can cause depressive symptoms as a side-effect.

Peter Simons
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According to new research, between 2013 and 2014, 38.4% of adults took a medication that lists depression as a potential side effect, and 9.5% received three or more such medications. About 23.5% took a drug that listed increased suicidality as a side effect. The researchers found that the use of these drugs was associated with people developing depression and suicidality.

“Use of prescription medications that have depression as a potential adverse effect was common and associated with greater likelihood of concurrent depression,” the researchers write.

The research, published in the Journal of the American Medical Association (JAMA), was led by Dima M. Qato, PharmD, MPH, PhD, at the Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, and also included Katherine Ozenberger, from that same institution, as well as Mark Olfson, a psychiatrist and public health specialist from Columbia University, New York.

Numerous medications include depression and suicidality as a potential side effect, including hormonal contraceptives, beta-blockers, proton pump inhibitors, anti-anxiety medications, and, paradoxically, “antidepressants” themselves.

The researchers found that rates of depression were higher in those taking medications that listed depression as a side effect. They controlled for numerous other factors, including gender, race, age, education level, socioeconomic status, marital status, employment, and multiple medical conditions (e.g., hypertension, cancer, diabetes, and many others).

The authors also controlled for potential confounds and reverse causality by using a statistical method called sensitivity analyses. For instance, the researchers conducted additional analyses to test if removing those who used psychotropic medications would alter the outcome, or if removing those who had hypertension (which is also associated with depression) would alter the outcome. In all of these cases, the association between medication use and depression continued to be statistically significant.

These results indicate that even when removing potential confounding cases (such as other psychotropic drugs, or people with illnesses linked to depression), there was still a link between medication use and the development of depression.

The connection between these drugs and depression were even more powerful for people who took three or more medications that had depression as a side effect. In fact, according to the researchers, about three times as many people who took three or more of these drugs developed depression when compared to those who were not on such medications:

“The estimated prevalence of depression was 15% for those reporting use of 3 or more medications with depression as an adverse effect vs 4.7% for those not using such medications.”

Their finding was not merely due to medication use in general—there was no difference in depression symptoms between those who took no medication and those who took even three medicines that did not have depression as a side effect. Thus, only drugs with depression listed as a side effect were associated with the development of depression.

According to the researchers, some of these medications are available over-the-counter (such as proton pump inhibitors and emergency contraceptives) in the US, and their packaging is often not thorough enough to describe the association of these drugs with depression and suicidality. Thus, consumers may not be aware that the medications they are taking could be responsible for their altered emotional state.

Additionally, the researchers note that calls for screening for depression have expanded considerably—yet screening instruments do not ask about potential medication side effects. Thus, screening for depression may result in someone receiving a diagnosis of depression (and potentially receiving antidepressants) when what is happening is that they are experiencing the side effect of another medication.

 

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Qato, D. M., Ozenberger, K., Olfson, M. (2018). Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States. JAMA, 319(22), 2289-2298. doi:10.1001/jama.2018.6741 (Link)

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

3 COMMENTS

  1. “Use of prescription medications that have depression as a potential adverse effect was common and associated with greater likelihood of concurrent depression.” It’s pretty pathetic that such an obvious reality has to be pointed out as “news” to the medical community. But it does, thanks.

    “… consumers may not be aware that the medications they are taking could be responsible for their altered emotional state.” Or we may question the drugs, but the doctors deny any of their drugs can ever have any adverse effects ever. Today’s doctors are totally insane people who even believe the opioids are “safe pain meds.” Thanks for the opium epidemic, doctors. Why did our country stop arresting drug pushers?

    “… the researchers note that calls for screening for depression have expanded considerably—yet screening instruments do not ask about potential medication side effects.” Are the drug companies writing the “screening instruments”? This flaw in the “screening instruments” needs to be corrected.

  2. Well over 10 years ago, now, I worked very closely with both a PCP/Primary Care Physician, and a licensed clinical psychologist. I took both Wellbutrin, and later Zoloft, for well over a year each. They did NOTHING for me, that I could tell. The psychologist said he *might* have noticed “some slight improvement”, but he couldn’t be sure. The only “change” I noticed, was that I found myself thinking in vague terms about the subject of suicide more often. I was never “suicidal”, – just found myself thinking about the general subject.
    So, yes, I can see how for some people, a prescription for “antidepressants” could also be a prescription for suicide. But, of course, a rising suicide rate means we need more money spent on more psychs and psych drugs, right?….

  3. Many drugs are so unnecessarily prescribed (for various conditions) these days – big pharma comes up with drugs often with only profits in mind and as we know, they indulge in various unethical practices (such as selective reporting and data mischaracterization) to get these drugs approved – these drugs must be ultimately getting into our ground water and tap water as well.

    Most of these drugs (although biochemically active) appear to somewhat work only due to the “placebo effect.” For example, meta analyses have shown that most active drugs and placebos have similar effect sizes (especially for health conditions that have continuous outcomes) – see the following reviews:

    Howick J, et al. (2013) Are Treatments More Effective than Placebos? A Systematic Review and Meta-Analysis. PLoS ONE 8(5): e62599.

    Kirsch, I. (2014). Antidepressants and the Placebo Effect. Zeitschrift Fur Psychologie. 222, 128-134.