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. 

7. Opioids

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.

8. Antidepressants

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

Ken Pope, Nayeli Y. Chavez-Dueñas, Hector Y. Adames, Janet L. Sonne, and Beverly A. Greene

Speaking the Unspoken: Breaking the Silence, Myths, and Taboos That Hurt Therapists and Patients (APA, 2023) 

“…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

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.

Yahoo News includes an article: “‘There’s a temptation to lump octogenarians together’: What you should know about work and aging-brain health.” 

Here are some excerpts:

In the upper echelons of politics, there’s no shortage of men and women working well past the conventional retirement age.

Sen. Dianne Feinstein, D-Calif., who turns 90 next month, has said she won’t seek reelection in 2024, but she continues to serve as the oldest member of the U.S. Senate,despite a recent extended medical absence and questions about her mental acuity. In the 2024 presidential election, voters are likely to face a standoff between President Biden, who will be 82 next November, and former President Trump, who will be 78.

Experts have said that working into old age can be beneficial and improve longevity — but only if it’s by choice; being forced to do so for financial reasons has the opposite effect. 

<snip>

So what are the cognitive challenges of working as an older adult — and what can aging professionals bring to the table?

What happens to the brain as we age?

A doctor looks at a magnetic resonance imaging (MRI) film that shows a neurodegenerative illness in an aging patient. 

The National Institute on Aging says that as we get older, it’s not just our bodies that begin to look different — physical changes occur in the brain as well. Certain areas of the brain begin to shrink, “especially those important to learning and other complex mental activities”; communication between nerve cells in certain regions may not be as effective; there’s more inflammation; and “blood flow in the brain may decrease.”

These physical changes can correlate with changes in mental function too, but experts say there’s no fixed, universal mold when it comes to aging.

“I just saw someone in my clinic yesterday who was 86, and she really looks like she’s in her late 60s or early 70s,” Dr. Sharon Sha, a clinical professor of neurology and chief of the Memory Disorders Division at Stanford University, told Yahoo News. “I’ve met 90-year-olds who run ultramarathons, so their joints and their cardiovascular function and their brain is not reflective of a typical 90-year-old. So yes, brains can be acting very differently.”

Sha also notes that while some changes in mental function are to be expected, we’re not all predestined to encounter dementia when we get older.

According to a recent study by Columbia University, almost 10% of U.S. adults ages 65 and older have dementia, and an additional 22% have mild cognitive impairment. Instances of cognitive impairment do increase with age, though they’re still in the minority; while 3% of people between 65 and 69 have dementia, that number rises to 35% of people ages 90 and over.

<snip>

What are some challenges to working as an octogenarian?

Even for an otherwise healthy individual, some cognitive changes are to be expected. Sha said that for many people that means changes in the following:

• Processing speed: “As we get older, there’s some decline in how quickly we’re thinking.”
  
• Working memory: “The amount of total information that we can hold can diminish slightly, but not to a significant amount.”
  
• Decreased attention and ability to multitask can also be affected.

“Our bodies are not what they once were,” David Myers, an 80-year-old professor at Hope College in Holland, Mich., said in an email to Yahoo News. 

“The stairs have gotten steeper, the newsprint smaller, others’ voices fainter, our sleep more interrupted. Our memories and reasoning are less speedy. We more often experience brain freezes as we try to retrieve someone’s name or the next point we were about to make.”

What benefits can older workers bring to the table?

Boat-building craftsman. 

Yet Myers said there are plenty of gifts as well as challenges to being a working octogenarian. As a social psychologist, Myers defies many of the conventional stereotypes affiliated with aging in the U.S.; he recently published a book of essays on “curiosities and marvels of the human mind” — the latest of 18 books he has written.

“There’s a temptation to lump octogenarians together, when actually their stamina and abilities vary much more than, say, 8-year-olds,” Myers said. “At 80, some are approaching death while others remain energized, purpose-filled and quick-witted.”

He said there are several advantages to being an older working professional:

• Crystallized intelligence: “Although we octogenarians don’t think as quickly (our ‘fluid intelligence’ is subsiding), our ‘crystallized intelligence’ — our lifetime of knowledge and the ability to apply it — remains strong.”
  
• Wisdom: “Older adults often benefit from a greater ability to keep things in perspective, to navigate conflicts and to appreciate the limits of their own knowledge. It takes experience to know what you don’t know.”
  
• Emotional stability: “As teens and young adults, we rode an emotional roller coaster. In later life, our feelings mellow. We’re better able to look beyond the moment. Compliments produce less elation, criticisms less despair or irritation. Thus when facing the day’s slings and arrows, we can better take a big-picture perspective.”
  
• The National Institute on Aging says there may be some positive cognitive changes too, with many studies showing that older adults “have more extensive vocabularies and greater knowledge of the depth of meaning of words than younger adults.”

How to keep your brain healthy and spry as you get older

Women doing yoga exercises at a park. 

While genes and family history can play some role in how well you age, the Centers for Disease Control and Prevention says that “up to 40% of dementia cases may be prevented or delayed.”

A lot of brain health comes down to lifestyle choices, and Sha shared a few pieces of advice that she usually gives to her patients for better brain aging — with one tip ranking the highest.

“Exercise, exercise, exercise. Research studies are really confirming how much aerobic exercise is important for brain health,” Sha said. “I think getting your heart rate up is important 30 minutes a day, if you can do that at the minimum.”

A heart-healthy Mediterranean diet — rich in plant-based foods like seeds, vegetables and whole grains as well as fish — can do wonders for the brain as well.

While there are no specific “brain games” that offer a surefire way to better brain health, cognitive stimulation plays a significant role too.

In addition to daily exercise, Myers says it is this “active engagement” that has helped him stay sharp into his 80s — “through reading and writing and interactions that keep my brain alive and growing, and my life still purpose-filled.”

Ken Pope

Ken Pope, Nayeli Y. Chavez-Dueñas, Hector Y. Adames, Janet L. Sonne, and Beverly A. Greene

Speaking the Unspoken: Breaking the Silence, Myths, and Taboos That Hurt Therapists and Patients (APA, 2023) 

Hector Y. Adames, Nayeli Y. Chavez-Dueñas, Melba J.T. Vasquez, & Ken Pope:

Succeeding as a Therapist: How to Create a Thriving Practice in a Changing World (APA, 2022)

Ken Pope, Melba J.T. Vasquez, Nayeli Y. Chavez-Dueñas, & Hector Y. Adames:

Ethics in Psychotherapy & Counseling: A Practical Guide, 6th Edition (Wiley, 2021)

“He not busy being born

Is busy dying.”

—Bob Dylan

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