One-third of adults in the U.S. may be unwittingly using prescription drugs that could cause depression or raise the risk of suicide, a study has found. A team of scientists at the University of Illinois at Chicago warned that over 200 commonly prescribed drugs carry warnings that depression or suicide are potential side effects. But patients and clinicians may be unaware of this link because the drugs may treat conditions unrelated to depression or mental health. Those include some painkillers; blood pressure and heart medication; hormonal birth control pills; proton pump inhibitors; and antacids. The study published in the Journal of the American Medical Association is thought to be the first to reveal that polypharmacy—where several drugs are taken at once—is associated with a heightened risk of depressive symptoms. Around 15 percent of participants who took three or more of the drugs identified in the study reported experiencing depressive symptoms while using them. In contrast, 5 percent of those who did not use the drugs and 7 percent of those taking one medication said they experienced depression. A further 9 percent of those who took two of the drugs felt depressed. The team found similar patterns in medications that listed suicide as a potential side effect. To compile their study, the researchers assessed data from the National Health and Nutrition Examination Survey, which documented the prescribed drug use of over 26,000 adults between 2005 and 2014. Dr. Dima Qato, assistant professor of pharmacy systems, outcomes and policy in the UIC College of Pharmacy, and author of the study said in a statement: "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. "People are not only increasingly using these medicines alone, but are increasingly using them simultaneously, yet very few of these drugs have warning labels, so until we have public or system-level solutions, it is left up to patients and health care professionals to be aware of the risks." Professor Andrea Cipriani, associate professor of psychiatry at the University of Oxford, U.K., said the paper is "important" but "not alarming" and highlighted two important caveats. "First, the risk of depression was higher in people that took more types of medicine and this may be a result of the medicines interacting, but it may also be because people with chronic illnesses take more medicines and are also more likely to have depression. This was an observational study so we cannot tease this apart. "Second, this study looked at many medications, including antidepressants. For many of the people who self-reported depression this may simply be because the particular antidepressants didn't work for them, or that they were biased towards expecting feelings of depression. It doesn't necessarily mean the antidepressants caused the depression." Professor David Baldwin, chairman of the Royal College of Psychiatrists' Psychopharmacology Committee, said: "The findings emphasize the need for doctors to ask about all prescription and over-the-counter medicines when patients have depressive symptoms. "If there is a risk of making those symptoms worse, especially where they are taking several medications, then the patient's condition might be improved by a change in their prescription. This could avoid unnecessary antidepressant treatment." Dr. Ian Anderson, professor at the division of neuroscience and experimental psychology at the U.K.-based University of Manchester, was not involved in the study. However, he told Newsweek the findings are potentially important for casting light on an area of medicine that is not usually considered. Further research is needed to unpack whether those who reported symptoms of depression were diagnosed with clinical depression; whether the medication or the participant's depression came first; and whether or not a drug having an association with depression in its side effects is to some extent arbitrary. "Those on drugs associated with depression could have had more conditions that themselves are associated with depression," Anderson argued. An analysis of those only on drugs associated with depression and those without the association would also make the results clearer. As for those concerned their medication could be causing depression, Anderson said the study shouldn't lead anyone to stop medicating, as this always needs to be discussed with a doctor. Anderson suggested that anyone whose mood has persistently worsened, especially inexplicably, after starting one or more medications should discuss this with a doctor. It may be possible to try an alternative treatment. "The interactions between multiple medications is extremely difficult to predict, so it's also worth asking whether all the medications being taken are needed, as far as simplifying medication regimes where possible," he said. This story has been updated with comment from Professor Ian Anderson.<doc-sep>“We know polypharmacy is growing, we know it is not always promoting good health and longevity in patients, and we know a lot of drugs have certain adverse effects — and one of them is depression and suicidal symptoms,” Qato said. “As a pharmacist, when a patient comes in and reports depressive symptoms, I just think it's really important to think about what other medications they are on.”<doc-sep>The incidence of depression has been rising in the U.S. for more than a decade. So has Americans’ reliance on prescription medications that list depression as a possible side effect. Coincidence? Perhaps not, according to a new study in the Journal of the American Medical Assn. Using 10 years of data collected from more than 26,000 Americans, researchers reported a significant link between the use of medications with the potential to cause depression and the chances of becoming depressed. Advertisement For example, among the 4,394 people who took one prescription drug that had depression as a possible side effect, 6.9% experienced depression. Of the 1,418 who took two such drugs, 9.5% became depressed, as did 15.3% of the 710 people who took three or more of the medications. Meanwhile, the prevalence of depression among the 17,039 who didn’t take any of these medications was 4.7%. All of these figures were adjusted for age, sex, race and ethnicity, education and job status, family income, body mass index and other health factors, according to the study. The researchers, led by Dr. Dima Mazen Qato of the College of Pharmacy at the University of Illinois at Chicago, conducted the same analysis with medications that did not list depression as a possible side effect. In this case, the prevalence of depression among those who didn’t take any such drugs (5.5%) was not significantly different statistically from the prevalence for those who took one or more medications not linked to depression. The rates of depression among this group were 6.6% for those taking one drug, 5.1% for those taking two, and 6% for those taking three or more. The data in the study came from the National Health and Nutrition Examination Survey, a project of the Centers for Disease Control and Prevention. Qato and her team focused on five consecutive survey cycles, starting with the one taken in 2005 and 2006 and ending with the most recent, done in 2013 and 2014. Participants received home visits from interviewers who asked to see all prescription medications they had taken in the previous 30 days. Researchers then used the Micromedex database to look up side effects for each of the drugs. Of particular interest were “depression,” “depressive disorder,” “suicide,” “suicidal thoughts,” “suicidal ideation” and “suicidal behavior,” the study said. The researchers tallied more than 200 medications that listed at least one of these side effects. Altogether, 37% — representing more than 1 in 3 Americans — took at least one of the drugs on the list. Among the most common medications with such side effects were antidepressants (taken by 15.1% of participants in the study’s most recent years), gastrointestinal agents to treat conditions like acid reflux (taken by 9.5% of study participants), beta blockers for high blood pressure (taken by 7.9% of participants), hormones used to prevent pregnancy or treat symptoms of menopause (taken by 7.8% of participants), anticonvulsant drugs (taken by 7.7% of participants) and prescription pain relievers (taken by 7.4% of participants). Advertisement In the earliest years of the study, 6.9% of people used at least three drugs that listed depression as a possible side effect. By the end of the study period, that figure had risen to 9.5% — a difference that was large enough to be statistically significant. In addition, the proportion of people who took at least one drug that listed suicidal symptoms as a possible side effect rose from 17.3% to 23.5% over the course of the study. That increase was also statistically significant. The researchers conducted a separate analysis that excluded people taking antidepressants. Even then, depression was found in 8.5% of those taking three or more drugs with the potential to cause it, compared with 4.5% of those who took no such drugs, according to the study. The survey data did not include information on participants’ mental health histories, so the study’s authors could not take that into account. Nor could they tell whether people had used over-the-counter medications that could have depression as a side effect, among other limitations. Advertisement Still, the findings fit with other recent studies that have linked the use of proton pump inhibitors or oral contraceptives with increased odds of depression. They do not show that prescription medications are responsible for an increase in depression — only that there is a correlation between the two. That should prompt doctors and patients to be mindful of the potential side effects of common prescription drugs, especially if they are taking more than one, the study authors concluded. “Physicians should consider discussing these associations with their patients who are prescribed medications that have depression as a potential adverse effect,” they wrote. The study was funded by the Robert Wood Johnson Foundation. Advertisement karen.kaplan@latimes.com Follow me on Twitter @LATkarenkaplan and “like” Los Angeles Times Science & Health on Facebook. MORE IN SCIENCE Psychedelic drugs change brain cells in ways that could help fight depression, addiction and more Advertisement Suicides have increased by more than 30% since 1999 in half the states, CDC says Africa’s baobab trees can live for more than 1,000 years, but many of the oldest and largest are dying<doc-sep>
This week, a new study highlighted the fact that there are many prescription drugs on the market that have been linked to depression—and many people may be taking at least one of them. The study, which was published in JAMA, found that more than one-third of Americans are taking at least one prescription drug that lists depression as a potential side effect. On top of that, people who take those drugs have higher rates of depression than those who don’t. For the study, researchers from the University of Illinois at Chicago and Columbia University analyzed U.S. population-based survey data from the National Health and Nutrition Examination Survey that was collected between 2005 and 2006 and collected again between 2013 and 2014. Overall, data from 26,192 adults were part of the study, and experts found that 37.2 percent of them used medications with depression listed as a potential side effect (including painkillers, hormonal birth control, and psychiatric medications among many others). Additionally, the number of people using these medications increased during the years studied from 35 percent between 2005 and 2006 to 38.4 percent in 2013 and 2014. Of the people studied, 7.6 percent reported having depression. And 6.9 percent of people reported using three or more medications with depression as a potential side effect—and those people were also more likely to report having depression than those taking fewer medications. Specifically, 15 percent of people who took three or more medications with depression listed as a potential side effect reported having depression compared to 4.7 percent of people who didn’t use those medications. “It's a reminder that while many prescription medications have therapeutic benefits, they also carry risks, including depression,” lead study author Dima Mazen Qato, Ph.D., Pharm.D., an assistant professor and pharmacist at the University of Illinois at Chicago, tells SELF. However, it’s not totally clear how certain medications impact your risk for depression, if at all. The study found that about 200 prescription drugs list depression as a potential side effect, including medications like hormonal birth control pills, emergency contraceptives, prescription-strength ibuprofen, proton pump inhibitors (which are used to treat acid reflux), beta-blockers (which treat high blood pressure), and corticosteroids like prednisone (which is used to treat a range of conditions, including arthritis, severe allergies, and skin diseases). Clearly, this encompasses a pretty wide range of health issues and drugs that people might take to help those conditions, so it's not all that surprising that so many people are taking drugs that list depression as a possible side effect. But these drugs don't all share some common mechanism that might increase your risk for developing depression, Jamie Alan, Ph.D., Pharm.D., an assistant professor of pharmacology and toxicology at Michigan State University, tells SELF. So if they actually do increase the risk, the way they do so “really varies per medication,” she explains. “Some, like drugs for hepatitis, are directly related [to depression], while for other drugs the mechanism isn’t entirely known.” There could even be a separate factor that's associated with a greater likelihood of depression and a greater likelihood of taking that medication that is actually to blame. Depression is a complicated disorder, and it can be difficult to attribute it to any one thing, like a medication. Study coauthor Mark Olfson, M.D., M.P.H., a professor of psychiatry and epidemiology at Columbia University Medical Center, tells SELF that it’s important to keep all of this in perspective. “A great majority of people who were taking these medications, even those who were taking three or more of them, were not depressed,” he notes.