Are Your Medications Causing Depression?

However you choose to view the statistics, it’s clear that more than half of us are existing, daily, under the influence of polypharmacy; that is, simultaneously using multiple medications, day after day. While polypharmacy may be most common among the elderly, affecting about 40% of elderly adults (Haider et al., 2007), these drugs were prescribed across all age groups; for example, nearly 1 in 4 women ages 50-64 are taking an antidepressant (Mayo Clinic, 2013).

If you’re curious as to which meds are most frequently prescribed, the leaders are, ranked in order of frequency: 1) antibiotics; 2) antidepressants; 3) opioids; 4) statins; 5) blood pressure meds; and 6) vaccines (including flu shots).

A Common Polypharmacy Side Effect: Depression

It’s no secret that all medications carry the risk of side effects. But a 2018 University of Chicago study was the first to demonstrate that simultaneous use of prescription medications is associated with a greater likelihood of experiencing depression.

In fact, researchers found that more than one-third (37.2%) of U.S. adults are taking at least one medication that can trigger depression and/or increase the risk of suicide (Qato et al., 2018)… and worse, they probably don’t even know it.

Now, these meds didn’t even include antidepressants, which we know have been linked to increased risk of suicide and suicide attempts. No, this broad spectrum of medications includes more than 200 commonly prescribed drugs such as: hormonal contraceptive medications, beta-blockers, blood pressure and heart medications, proton pump inhibitors, antacids and painkillers.

The strength of the evidence, so far, varies across medication classes. For hormonal contraceptives, the evidence is mounting; for example, a compelling 2017 Danish study found that hormonal contraceptives increase the risk of suicide and suicide attempt in previously mentally healthy women (Skovlund, 2017). Several other studies have linked hormonal contraception to depression and adverse mood affects.

Depression has also been consistently associated with interferon α treatment of hepatitis C, with mild to moderate depression developing in 45% to 60% of treated patients and moderate to severe depression developing in 15% to 40% (10-12 Raison et al., 2005; Musselman et al., 2001; Schaefer et al., 2012).

Additionally, many commonly used antihypertensives (e.g., β-blockers) have also been associated with depression as an adverse effect (Boal et al., 2016).

But the Qato et al. study found that prescription meds are not the only culprits in the polypharmacy-depression link. Some of those 200+ medications, including proton pump inhibitors and the emergency contraceptive levonorgestrel, are also available over the counter (OTC).

One survey reports that 75% of people taking prescription medication also take at least one OTC drug regularly (Consumer Reports, 2017), which further increases the risk of adverse drug effects.

And what’s especially dangerous is that product labeling for OTC medications is unlikely to include comprehensive information about adverse effects, including depression. That’s the epitome of a buyer-beware situation — it’s left up to the patient to know the risks.

Researchers analyzed the medication use patterns of more than 26,000 adults from 2005 to 2014 (mean age 46.2-years-old), collected through the National Health and Nutrition Examination Survey.

They found that the greater the number of medications used, the greater the prevalence of concurrent depression…

• The likelihood of concurrent depression was most pronounced among those adults using 3 or more medications with depression as a potential adverse effect, including antidepressants. 15% of adults who simultaneously used 3 or more of these medications experienced concurrent depression (compared with 4.75% for those not using medication)
• 9% of those taking 2 drugs simultaneously experienced concurrent depression
• 7% of those using 1 medication experienced concurrent depression

Overall, researchers found similar patterns of depression concurrent with polypharmacy in restricted analyses that excluded anyone using psychotropic medications (including antidepressants), as well as similar patterns for drugs that listed suicide as a potential side effect.

Adults with hypertension who were using three or more medications that have depression as a potential adverse effect were also significantly more likely to report depression than were adults with hypertension who were not using these medications.

The results of this study suggest that, in terms of developing depression, taking multiple, concurrent common medications that have nothing to do with depression may be every bit as dangerous as taking medications for which depression and suicide risk are known side effects.

The Polypharmacy-Depression Problem is Getting Worse

The number of prescriptions filled for American adults and children rose 85% (from 2.4 billion to 4.5 billion a year) between 1997 and 2016. But we can’t blame it on population growth. The total U.S. population only increased 21% during that period (Consumer Reports, 2017).

Numerous studies suggest that polypharmacy is on the rise, too, and as more and more people add more and more medications, the polypharmacy-depression problem can only get worse.

The Qato et al. study, in fact, documented this increasing polypharmacy-causing-depression trend, particularly with suicidal symptoms as an additional potential adverse effect.

Highlights of their findings include:

• Use of any prescription medication with a depression adverse effect increased from 35% from 2005-2006 to 38.4% in 2013-2014.
• 6.9% used three or more concurrent medications with a potential depression adverse effect in 2005-2006, increasing to 9.5% in 2013-2014.
• Use of antacids with potential depression adverse effects (e.g., proton pump inhibitors and H2 antagonists) increased from 5% to 10% in the 2005-2014 period.
• Use of three or more medications concurrently increased from 7% to 10% in the 2005-2014 period.
• For prescription drugs with suicide listed as a potential side effect, usage increased from 17.3% to 23.5% in the 2005-2014 period.

As prescription drug use increases, so should our concerns about polypharmacy. Beyond the polypharmacy-depression link, using multiple drugs concurrently can only increase the risk of other drug interactions, adverse drug effects, and reduced functional capacity (Maher et al., 2014).

What Should Multiple-Meds Users Do?

Our specialist-driven health care system has a tendency to splinter — or even effectively, eliminate — medication oversight by physicians. The 2017 Consumer Report found that 53% of those who take prescription drugs get them from more than one health care provider, which, of course, only increases the risk of adverse drug effects and decreases the likelihood of physician oversight. Thirty-five percent of them said that no single provider has reviewed their medications to see if they could stop taking any of them (Consumer Reports, 2017).

Too often, patients are left to fend for themselves, forced to substitute their own judgment about complicated medication decisions for their physicians, all the while worrying that doing so may risk-averse consequences. But awareness of the risks and education about safer, natural alternatives can empower you to provide — or withhold — truly informed consent.

At the very least, the evidence that polypharmacy can lead to depression and even increased risk of suicide should spur discussions with doctors about the link between their medications and the risk for depression. One bit of good news from the Consumer Reports survey… When 49% of those regularly taking prescription medications asked their prescribers whether they could stop taking a drug, 71% were able to eliminate at least one.

But on the other hand, should they have had to ask? Shouldn’t their doctors have been providing more vigilant oversight all along?

Ask yourself if you’re better off medication-free. This typically requires addressing the reason that you were placed on meds in the first place – putting out the fire instead of just turning off the smoke detector. If you’re currently taking multiple medications, I encourage you to learn more about tapering off psychotropic drugs (e.g., antidepressants or antipsychotics) and other prescription medications, and ultimately, investigate alternatives that may allow you to live a medication-free life.

Interested in a comprehensive, drug-free approach to healing anxiety, depression or chronic stress?

The Vital Mind Reset program walks you through my 44-day healing protocol, which combines diet, detox, and meditation practices for long-term resolution of chronic symptoms. The tools implemented also help to establish a readiness for psychiatric medication tapers. Click below to learn more.

References:

• Boal,AH, Smith, DJ, McCallum, L, et al. (2016) Monotherapy with major antihypertensive drug classes and risk of hospital admissions for mood disorders. Hypertension, 68(5):1132-1138. doi: 10.1161/HYPERTENSIONAHA.116.08188
• Centers for Disease Control and Prevention (CDC) (2017) Health, United States, 2016, With Chartbook on Long-term Trends in Health. DHHS Publication No. 2017-1232.
• Consumer Reports National Research Center. (2017) Consumer Reports, August 3, 2017. https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/#nation. Last retrieved June 18, 2018.
• Haider, SI; Johnell, K; Thorslund, M; Fastbom, J (2007). Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992 – 2002. International Journal of Clinical Pharmacology and Therapeutics. 45 (12): 643–653. doi:10.5414/cpp45643. PMID 18184532.
• Maatouk, I, Herzog, W, Böhlen, F, et al. (2016) Association of hypertension with depression and generalizedanxietysymptomsinalarge population-basedsampleofolderadults.Journal of Hypertension, 34(9):1711-1720. doi:10.1097/HJH .0000000000001006
• Maher RL, Hanlon J, Hajjar E. (2014) Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety. 13(1):1– 11.
• Mayo Clinic & Olmsted Medical Center. (2013) Nearly 7 in 10 Americans are on prescription drugs. Mayo Clinic Proceedings. Rochester, Minnesota. 93(6).
• Musselman, DL,Lawson, DH, Gumnick, JF, et al. (2001) Paroxetine for the prevention of depression induced by high-dose interferon alfa. New England Journal of Medicine, 344(13):961-966. doi:10.1056 /NEJM200103293441303
• Qato, Dima Mazen, Ozenberger, Katharine, Olfson, Mark. (2018) Prevalence of Prescription Medications With Depression as a Potential Adverse Effect Among Adults in the United States. JAMA, 319 (22), 2289. DOI: 10.1001/jama.2018.6741
• Raison, CL, Borisov, AS, Broadwell, SD, et al. (2005) Depression during pegylated interferon-alpha plus ribavirin therapy: prevalence and prediction. Journal of Clinical Psychiatry, 66(1):41-48. doi:10.4088 /JCP.v66n0106
• Schaefer, M, Capuron, L, Friebe, A, et al. (2012) Hepatitis C infection, antiviral treatment and mental health: a European expert consensus statement. Journal of Hepatolpgy, 57(6):1379-1390. doi:10.1016/j.jhep.2012.07.037
• Skovlund, Charlotte Wessel Ph.D., Mørch, Lina Steinrud Ph.D., Kessing, Lars Vedel D.M.Sc., Lange, Theis Ph.D., Lidegaard, Øjvind D.M.Sc. (2017) Association of Hormonal Contraception With Suicide Attempts and Suicides. Psychiatry, 175(4), 336-342.