A collection of postings on a range of issues is available on our website (www.mjacksongroup.ca). This month’s post is again from Ken Pope’s listserv, where he kindly provides daily summaries of current articles in the field.
Good Rx released a report:
8 Medications That Can Cause Depression as a Side Effect
Have you ever felt depressed or know someone who has depression? It’s likely. Depression is a common mental health condition that’s estimated to affect at least 5% of adults worldwide. And since many cases of depression go under the radar, this number is likely much higher.
There are often underlying themes among people who experience symptoms of depression. Certain factors can increase your risk for it, including brain function, genetics, and your life circumstances. It doesn’t help when medications add to this list and cause or exacerbate your symptoms.
Here, we’ll discuss eight common medications that have been linked to new or worsening depression.
1. Corticosteroids like prednisone
Corticosteroids are medications that treat a wide range of inflammatory health conditions. They work by reducing swelling in your body and calming the activity of your immune system. Top examples are prednisone, dexamethasone, and methylprednisolone (Medrol).
Corticosteroids can cause imbalances in neurotransmitters, or chemical messengers, in your brain. These changes have the potential to affect your mental health. Corticosteroids have been shown to increase the risk of depression, anxiety, and insomnia in some cases. Irritability is also possible.
Thankfully, this doesn’t happen to everyone. Mood symptoms caused by corticosteroids depend on your medication dose and usually occur during the first few weeks of treatment. Developing depression is also less likely among people taking a short-term steroid burst or applying a steroid medication topically to your eyes, skin, or joints.
2. Parkinson’s medications like Sinemet
Depression is common in people living with Parkinson’s disease. The condition itself can cause changes in brain chemistry that contribute to depression and anxiety.
Medications used to treat Parkinson’s disease can also cause depression. According to one study, levodopa can worsen depression — especially when used at high doses. Levodopa is a key ingredient in Sinemet (carbidopa/levodopa), a common Parkinson’s medication.
On the other hand, the same study found no link between dopamine agonist use and depression. Dopamine agonists are another option for treating Parkinson’s disease and work by raising dopamine levels in the brain. Examples of these Parkinson’s medications include ropinirole, pramipexole, and rotigotine.
3. Hormonal contraceptives
Hormonal contraceptives are a type of birth control that use specific versions of estrogen and/or progestin (sex hormones) to prevent pregnancy. Some common examples include birth control pills or patches, intrauterine devices (IUDs), and vaginal rings.
Research studying the link between hormonal contraceptives and depression has gone back and forth. The true answer likely lies somewhere in the middle. For instance, one large study found that hormonal contraceptives could increase your depression risk by a small amount.
However, the study did find that depression was more likely to happen among certain hormonal contraceptive users:
- Teens ages 15 to 19 years old
- Women taking progestin-only contraceptives (such as the “mini-pill”)
- Women using non-oral forms of hormonal contraception, such as a patch or vaginal ring
4. Stimulants like Adderall
Stimulantslike Adderall (amphetamine salts)are popular drugs for conditions like ADHD (attention-deficit hyperactivity disorder) and narcolepsy. In many cases, these medications work to improve your attention and mood.
However, stimulants are controlled substances. They come alongside a risk for misuse and dependency. What’s more, depression can occur in people who are experiencing withdrawal from stimulants like Adderall. Be sure to follow your healthcare provider’s instructions carefully when taking and stopping a stimulant.
5. Anticonvulsants like lamotrigine
Anticonvulsants, or antiepileptics, are medications that treat seizure disorders. While some of these medications can improve your mood, others can worsen it. Lamotrigine (Lamictal, Lamictal XR), gabapentin (Neurontin, Horizant), and phenytoin (Dilantin, Phenytek) are common examples.
All anticonvulsant medications have an FDA-required warning on their label that says they have a risk for causing suicidal thoughts and behavior. However, some health experts have mixed opinions on this. For instance, epilepsy alone can increase the risk of developing depression. Untreated epilepsy also poses a larger risk than the relatively small risk of mental health changes with these medications.
All the same, it’s important to remember that anticonvulsants have the potential to affect your mood. You should contact your healthcare provider if you experience any changes in your mental health status after starting a new anticonvulsant medication.
6. Proton pump inhibitors like omeprazole
Proton pump inhibitors (PPIs) are popular medications used to lower stomach acid. You may be familiar with many of them, such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium).
In a recent study analyzing the mood of more than 16,000 adults in the U.S., PPIs were found to potentially increase the risk of depression. They could also increase the risk of suicidal thoughts or behavior. Another study found that 14% of depression cases could be avoided by stopping PPIs.
Health experts are still learning about the effects of PPIs on mental health. If you’re concerned about the risk of depression with PPIs, make sure to have a discussion with your healthcare provider.
Opioids are strong pain-relieving medications. They’re effective for this purpose, but they also have a number of risks attached to them. One of these is an increased risk of depression. Examples of opioids are tramadol, oxycodone, and methadone.
One study found that around 10% of people prescribed opioids may develop depression at some point. People who took opioids for 30 days (1 month) or longer were more likely to develop depression.
Although it may sound strange, starting an antidepressant can initially make your depression symptoms feel worse. Antidepressants don’t actually make your depression worse, but their initial side effects can be similar to the symptoms of depression (being tired, changes in sleep and appetite, etc.).
These side effects can make you second guess starting an antidepressant in the first place. But rest assured that this is normal. For most people, these side effects are temporary. You should start to notice a positive difference within a few weeks, and you should feel the medication’s full benefits within 4 to 8 weeks.
You shouldn’t stop taking an antidepressant without talking to your healthcare provider first.
When should I contact my healthcare provider about medications that cause depression as a side effect?
It’s important to talk with your healthcare provider if you’re feeling depressed at any point. When discussing your symptoms, include details about any medications you’re currently taking and those you’ve taken in the recent past. Being thorough with your medication list is important — many different types of medications can cause depression, not just the ones discussed above.
With this information, your healthcare provider can determine if any of your medications could be contributing to your symptoms. If so, they can help you decide if your medications need to be changed or if you should seek additional help from another healthcare professional.
The bottom line
Depression is a possible side effect of many medications, such as corticosteroids, anticonvulsants, and opioids. However, many of the health conditions these medications treat can also cause depression. If you’re experiencing depressive symptoms or worsening mental health changes, talk with your healthcare provider to determine the best path forward.
If you or someone you know is struggling with depression or has had thoughts of harming themselves or taking their own life, get help.
The National Suicide Prevention Lifeline (988) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations.
Ken Pope, Nayeli Y. Chavez-Dueñas, Hector Y. Adames, Janet L. Sonne, and Beverly A. Greene
“…the Law of Unintended Consequences, stronger than any written Law. ‘Whether or not what you do has the effect you want, it will have three at least you never expected, and one of those usually unpleasant.'”
—James Oliver Rigney, Jr. (1948-2007) writing under the pen name Robert Jordan, The Wheel of Time