More than one in three Americans may be taking prescription medications that can lead to depression or increase the risk of suicide, according to a new study conducted by researchers at the University of Illinois at Chicago (UIC).
And since many of these medications are common and not associated with depression — such as hormonal birth control medications, blood pressure and heart medications, proton pump inhibitors, antacids and painkillers — patients and clinicians may be unaware of the risks.
The findings are published in the Journal of the American Medical Association.
For the study, the research team looked at the medication use patterns of more than 26,000 adults from 2005 to 2014. The data was taken from the National Health and Nutrition Examination Survey. Their findings show that more than 200 commonly used prescription drugs have depression or suicide listed as potential side effects.
The research is the first to show that these drugs are often used concurrently and that concurrent use, called polypharmacy, is linked to an increased risk of depression.
The findings also show that about 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 found similar results for medications that listed suicide as a potential side effect. These findings remained strong even 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 UIC 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.”
Qato notes that the findings reveal a trend of increasing polypharmacy for medications that list depression, particularly suicidal symptoms, as a potential adverse effect. This makes the need for awareness of depression as a potential side effect even more urgent.
The study finds that the use of any prescription medication listing depression as a potential side effect increased from 35 percent in the 2005 to 2006 period to 38 percent in the 2013 to 2014 period. The use of antacids with potential depression adverse effects, such as 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 around 7 percent to 10 percent.
For medications with suicide listed as a potential side effect, usage increased from 17 percent to 24 percent, and use of three or more drugs concurrently increased from 2 percent to 3 percent.
“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,” Qato said.
“With depression as one of the leading causes of disability and increasing national suicide rates, we need to think innovatively about depression as a public health issue, and this study provides evidence that patterns of medication use should be considered in strategies that seek to eliminate, reduce or minimize the impact of depression in our daily lives.”
Co-authors on the study are doctoral student Katharine Ozenberger of UIC and Columbia University’s Mark Olfson, M.D., M.P.H. Qato and Olfson both noted financial disclosures potentially relevant to the study.
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