Depression may be a side effect of some common drugs, including ones for acid reflux and hypertension - The Washington Post
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All medications have the potential to cause unwanted side effects, and depression is among them. One-third of Americans are now taking meds that can cause this mood disorder, according to a study published in the Journal of the American Medical Association in June. Other research has had similar findings, but this is the largest review on the topic to date.
The study authors found that about 200 prescription drugs, including some often used by older adults — such as proton-pump inhibitors (PPIs) to treat acid reflux and beta blockers for hypertension — can lead to depression.
But doctors may not know this. “Many physicians may not be aware that several commonly prescribed medications are associated with an increased risk of this disorder,” says study author Mark Olfson, professor of psychiatry and epidemiology at the Columbia University Irving Medical Center in New York.
In the study, the more drugs people took, the higher their depression risk. About 7 percent of those taking one such drug were depressed compared with 15.3 percent of those taking at least three.
This is concerning for older adults, who may take multiple medications and are more vulnerable to drug side effects, says Michael Hochman, an associate professor of clinical medicine at Keck Medicine at the University of Southern California in Los Angeles.
But even if you’re taking medications linked to depression, they’re not necessarily the cause. “It’s important to bear in mind that most people taking these medications, even those who are on three or more of them, don’t have depression,” Olfson says.
“Sometimes, people were depressed before they started medications, or various health conditions have left them depressed,” explains Igor Galynker, professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York.
For instance, up to half of people with chronic pain also have depression or another mood disorder — because parts of the brain that are involved in perceiving pain also affect mood.
Still, it’s wise to keep the connection in mind, and to know when a drug might be affecting your mood.
The following are among those that may lead to depression:
1. Beta blockers and angiotensin-converting-enzyme inhibitors (blood pressure drugs): metoprolol, atenolol, enalapril and quinapril.
2. Antidepressants: sertraline (Zoloft and generic), citalopram (Celexa and generic), bupropion (Wellbutrin and generic) and amitriptyline.
3. Anti-anxiety drugs: alprazolam (Xanax and generic), clonazepam (Klonopin and generic), diazepam (Valium and generic), and lorazepam (Ativan and generic), as well as the sedative zolpidem (Ambien and generic).
4. Opioids: hydrocodone combination meds (Lorcet, Norco, Vicodin, generic and more) and tramadol (ConZip).
5. Corticosteroids: prednisone and others.
6. Over-the-counter proton-pump inhibitors: omeprazole (Prilosec, Zegerid and generic) and esomeprazole (Nexium and generic), as well as the antacids ranitidine (Zantac and generic) and famotidine (Pepcid and generic).
7. Allergy and asthma medications: over-the-counter cetirizine (Zyrtec and generic) and the prescription drug montelukast (Singulair).
8. Anticonvulsants: gabapentin (Neurontin and generic) and topiramate (Topamax and generic).
9. Hormones: estradiol (Delestrogen, Elestrin, EstroGel and generic) and finasteride (Proscar, Propecia and generic).
Whether you take multiple meds or none, if you’re experiencing a low mood for two consecutive weeks or more, let your doctor know.
Other depression symptoms to watch for include loss of interest in pleasurable activities, appetite or weight changes, insomnia or sleeping too much, severe fatigue, trouble concentrating, feeling worthless, and recurrent thoughts of death or suicide.
Don’t wait for your doctor to ask about your mood at your next visit, Olfson says. In one study published in Psychiatry Online in 2018, only about 3 percent of primary-care visits included a depression screening.
You can also take an online test, such as the PHQ-9, says Michelle Riba, associate director of University of Michigan Comprehensive Depression Center in Ann Arbor.
When you talk to your doctor, ask whether any of your meds could be the cause. And consider bringing all your regular prescription and OTC medications with you so that your doctor can look them over. (You should do this kind of “brown-bag review” at least once a year, whether you’re feeling depressed or not.)
If your physician doesn’t seem well versed in the side effects of your medications, make an appointment with the pharmacist where you get prescriptions filled, says Joan Baird, director of pharmacy practice and government affairs at the American Society of Consultant Pharmacists.
While drug-related depression symptoms can crop up at any time, you’re most likely to see them within the first month of use, Olfson says.
So every time your physician prescribes a new medication, ask whether depression is a possible side effect. If so, keep a journal so that you can jot down any mood-related side effects you notice, including the day and time when symptoms occur. Report any symptoms that persist for more than a week or two to your doctor immediately.
If medication seems to be the cause, talk to your doctor. Sometimes the fix is as simple as cutting the dose.
If the lower dose makes little difference in mood or doesn’t work well for your physical health, your doctor should switch you to another class of drugs, says Philip Muskin, professor of psychiatry at Columbia University Irving Medical Center.
Depending on your health status, you may be able to stop taking a medication altogether — but never stop a regular prescription drug without discussing it with your doctor.
If you can’t safely reduce a dose or stop taking a medication, ask your doctor about other ways to get your mood back to baseline.
One 2011 University of Texas Southwestern Medical Center study published in the Journal of Clinical Psychiatry found that 28 percent of sedentary people being treated for depression reported improvements in their condition three months after beginning moderate or brisk walking routines.
The next step might be talk therapy — or, if your depression doesn’t ease sufficiently, antidepressant medication. Keep in mind that some antidepressants may trigger anxiety.
Copyright 2018, Consumer Reports Inc.
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