If you take Prilosec or Zantac for acid reflux, a beta blocker for high blood pressure, or Xanax for anxiety, you may be increasing your risk of depression.
More than 200 common medications sold in the U.S. include depression as a potential side effect. Sometimes, the risk stems from taking several drugs at the same time. Now, a new study finds people who take these medicines are, in fact, more likely to be depressed.
The list includes a wide range of commonly taken medications. Among them are certain types of proton pump inhibitors (used to treat acid reflux), beta blockers, anxiety drugs, painkillers including ibuprofen, ACE inhibitors (used to treat high blood pressure) and anti-convulsant drugs.
"The more of these medications you're taking, the more likely you are to report depression," says study author Mark Olfson, a professor of psychiatry at Columbia University.
The study, which was published Tuesday in JAMA, the journal of the American Medical Association, included 26,192 adults who participated in a federal survey, the National Health and Nutrition Examination Survey. All of the participants listed the medications they were taking at the time of the survey. In addition, they each completed a depression screening, the Patient Health Questionnaire (PHQ-9), which asks about sleep, mood and appetite.
More than a third of the people who took the survey were taking medications known to have depression or suicidal thoughts as potential side effects. Olfson and his collaborators wanted to determine whether those participants were more or less likely to be depressed, compared to participants who didn't take any of these medications.
"What we found is that, in fact, they're more likely," Olfson says. And they found that people who took three or more of the medications were three times as likely to be depressed.
About 15 percent of participants who simultaneously used three or more of these drugs were depressed. By comparison, among participants who didn't use any of the medications, just 5 percent were depressed. Even those who used just one of these medications were at slightly higher risk of depression: About 7 percent were depressed.
Olfson says the study does not prove that the medications caused the depression. "We're just showing that if you're already taking them, you are more likely to be depressed," he says. To determine causation, he says, researchers would need to follow people over time — beginning at the time they start taking the medications — to see if they're more likely to develop depression.
Nonetheless, Olfson says, he was surprised by the "strength of the association between the number of medications and the likelihood of being depressed."
These findings may motivate people to ask their health care providers more questions. "People should always be ready to ask, 'What are the risks and the benefits of me taking this medication?' " says Don Mordecai, a psychiatrist with Kaiser Permanente in San Jose, Calif. And he says doctors should be ready to have these conversations, too.
Mordecai says, if you start a new medicine it can be helpful to keep track of changes in how you feel.
"People who don't have a history of depression and then, suddenly, start to have symptoms of depression should be concerned that it's potentially due to a side effect, or potentially, an interaction," Mordecai says.
It's also worth having a conversation with your doctor about whether you might be able to stop a medication, Mordecai says. For instance, it may be possible to go off — or reduce — a medication for high blood pressure if you make other changes "such as changing your diet, limiting salt intake, or increasing exercise."
Use of medications with depression or suicidal thoughts as potential side effects has been on the rise, according to the study's lead author, Dima Mazen Qato, an assistant professor at the College of Pharmacy of the University of Illinois, Chicago.
"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 wrote in a release about the study findings.
Qato says physicians may want to consider including evaluations of medications when they screen for depression.
"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," Qato writes. She suggests that one strategy to reduce depression rates might be for health care providers to give more thought to the role these medications might play in depression risk.
Allison Aubrey is on Twitter: @AubreyNPRFood.
Editor's note, June 13, 2018: The headline of this story has been changed to better reflect the content of the story.
AUDIE CORNISH, HOST:
A surprising number of common medications list depression or suicidal thoughts as possible side effects. Those meds include pills to treat acid reflux and anxiety as well as common painkillers and high-blood pressure medications. A new study published in The Journal of the American Medical Association finds that people who take these drugs are actually more likely to be depressed. NPR's Allison Aubrey reports.
ALLISON AUBREY, BYLINE: If you take medication such as Prilosec or Zantac for acid reflux, a beta blocker for high blood pressure or Xanax for anxiety, do you know about the possible side effects? Mark Olfson is a researcher and professor of psychiatry at Columbia University.
MARK OLFSON: If you take the time to actually go through the fine print and read the insert, you'll see that each of these medications is associated with depression as an adverse effect.
AUBREY: More than 200 medications have depression as a potential side effect. Sometimes the risk stems from taking several drugs at the same time. Olfson and his collaborators wanted to find out if people who take these drugs are any more or less likely to actually be depressed. To figure this out, they designed a study that included about 26,000 adults. Everyone in the study listed the medications they were on, and they were screened for depression. Olfson explains they took a survey that asks a range of questions.
OLFSON: They'll ask about people's sleep and their mood and their appetite and their ability to make decisions, thoughts about whether life is worth living, all the kind of basic symptoms of depression.
AUBREY: What happened next is the researchers analyzed the medication use and the depression screening results to look for a correlation. Were people taking the medications any more or less likely to have depression?
OLFSON: And what we found is that in fact they're more likely. And the more of these medications you're taking, the more likely you are to report depression.
AUBREY: Taking just one of these medications increased the risk slightly, and people who took three or more of these medications were about three times as likely to be depressed. Fifteen percent of them had depression compared to just 5 percent of people who took none of these medications. I asked Olfson if he was surprised by the findings.
OLFSON: Yes. I was surprised by the strength of the association between the number of medications and your likelihood of being depressed.
AUBREY: The findings are notable given how many people take drugs that are linked to depression. The study found about 1 in 3 adults in the U.S. is taking at least one of these drugs. Here's physician Don Mordecai. He's national leader for mental health and wellness at Kaiser Permanente.
DON MORDECAI: People should always be ready to ask, what are the risks and benefits of me taking this medication?
AUBREY: Mordecai says if you start a new medicine, keep track of changes and how you feel.
MORDECAI: People who don't have a history of depression and then suddenly start to have symptoms of depression should be concerned that that's potentially due to a side effect or potentially an interaction.
AUBREY: And he says you can talk to your doctor about stopping a medication. For instance, it may be possible to go off a high blood pressure medication if you make other changes.
MORDECAI: Such as changing your diet, limiting your salt intake, increasing exercise.
AUBREY: Strategies that could help you feel better and reduce the risk of depression. Allison Aubrey, NPR News.
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