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Could Your Depression Be Related to Your Medication?
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Could Your Depression Be Related to Your Medication?

After two weeks of taking isotretinoin (Accutane), an acne medication, 19-year-old Joe began experiencing fatigue, lack of motivation, sleep problems, and crying spells. He was diagnosed with depression (something his healthcare provider eventually believed was related to his use of Accutane). When Joe stopped taking the medication, his symptoms quickly resolved.

In 1998, the US Food and Drug Administration issued a warning about occurrences of depression, suicide, and psychosis in some people using the acne medication Accutane. But many consumers are unaware that numerous other medications can cause depression.

What is Depression?

Depression is a condition characterized by feelings of profound sadness and lack of interest in formerly enjoyable activities. Symptoms may include:

  • Persistent feelings of sadness, anxiety , or emptiness
  • Hopelessness
  • Feeling guilty, worthless, or helpless
  • Loss of interest in hobbies and activities
  • Loss of interest in sex
  • Feeling tired
  • Trouble concentrating, remembering, making decisions
  • Trouble sleeping, waking up too early, or oversleeping
  • Eating more or less than usual
  • Weight gain or weight loss
  • Thoughts of death or suicide, with or without suicide attempts
  • Restlessness or irritability
  • Physical symptoms that defy standard diagnosis and do not respond well to medical treatment

Medications Reported to Cause Depression

According to The Medical Letter on Drugs and Therapeutics (1998), the following medications have been reported to cause depression:

DrugGeneral Treatment Uses
Acyclovir (Zovirax)Chickenpox , shingles , herpes
AmphetaminesAttention deficit hyperactivity disorder , narcolepsy
Anabolic steroidsOften used illicitly by athletes to build muscle
Anticonvulsants Seizures, epilepsy , pain
Asparaginase (Elspar)Blood cancers
Baclofen (Lioresal) Muscle spasms, cramps, muscle tightness from multiple sclerosis , cerebral palsy , and spinal cord injuries
Barbiturates Seizures, insomnia
BenzodiazepinesAnxiety, convulsions, insomnia
Beta-adrenergic blockers (Beta blockers)Cardiovascular conditions
Bromocriptine (Parlodel) Menstrual problems, lactation problems, infertility, Parkinson’s disease , acromegaly , tumors of the pituitary gland
Calcium channel blockersCardiovascular conditions
Corticosteroids Inflammatory conditions, asthma , arthritis, cancer
Cycloserine (Seromycin)Tuberculosis
DapsoneLeprosy, dermatitis herpetiformis
Digitalis (Lanoxin, digoxin, digitoxin)Cardiac conditions
Disopyramide (Norpace)Abnormal heart rhythms
Disulfiram (Antabuse)Alcohol abuse
EstrogensMenopause , prevention of osteoporosis , certain cancers
Fluoroquinolone antibioticsBacterial infections in different parts of the body
Histamine H2-receptor antagonistsAcid-related diseases of the gastrointestinal tract
HMG-CoA reductase inhibitors (statins)Lipid disorders
Interferon alfa (Roferon-A)Hairy cell leukemia , malignant melanoma , AIDS-related Kaposi’s sarcoma , growths in the respiratory tract, genital warts , certain types of hepatitis
Isotretinoin (Accutane) Severe acne , rosacea , other skin diseases
Levodopa (Dopar)Parkinson’s disease
Mefloquine (Lariam)Malaria prevention and treatment
Methyldopa (Aldomet)High blood pressure
Metoclopramide (Reglan) Diabetic gastroparesis, nausea, vomiting, fullness after meals, loss of appetite, heartburn
Metrizamide (Amipaque)For diagnosis of brain disorders, cardiac disease, central nervous system disorders, urinary tract disorders, vascular disease
Metronidazole (Flagyl)Infections
NarcoticsPain
Nonsteroidal anti-inflammatory drugs (Naprosyn, Motrin, Relafen, Mobic, Aleve, Indocin, and others)Arthritis, inflammatory conditions, pain
Pergolide (Permax)Parkinson’s disease
Progestins, implanted (Norplant)Birth control
SulfonamidesInfections
Thiazide diureticsHigh blood pressure
Vinblastine (Velban)Certain cancers

Medication or Depression: Which Comes First?

Do certain medications cause depression or are people with depression more apt to take certain medications? The relationship is not always clear.

According to the National Institute of Mental Health, people taking medications that are linked to depression often have chronic conditions such as cancer or cardiovascular disease, or an unrecognized mental illness, which may also put them at risk for depression. Furthermore, people with chronic conditions may also be dealing with psychosocial factors, such as disability, unemployment, and other stressors that increase their risk for depression. It is also known that people with a personal history of depression are more likely to experience depression as an adverse reaction to certain medications. Nonetheless, drug-induced depression does not generally meet diagnostic criteria for “major depressive disorder”; instead, it more commonly resembles “atypical depression,” suggesting that drugs may indeed be the cause in affected individuals.

The elderly may be at higher risk for drug-induced depression. Many elderly persons take multiple medications, and it is possible that drugs which may not cause depression when given by themselves could do so when given in combination. While many drugs (as in the above list) have been thought to be able to cause depression, rigorous studies provide at least limited evidence for causation in only a few. Among these better-proven causes are mefloquine, alpha interferon, interleukin-2, gonadotropin-releasing hormone agonists, progestin-releasing implanted contraceptives, corticosteroids, and propranalol. Of these drugs, only the final three are used with any frequency in general medical practice. The others are typically used to treat serious or life-threatening conditions in persons under close medical supervision.

Talk to Your Doctor

Most people who take any of the medications above will not become depressed. And not all cases of depression in people taking these medications will be a result of the medication. However, if you are taking one or more of these medications and have been feeling unusually sad, talk to your doctor about it. But even if you are not taking medications on the list, talk to your doctor about any symptoms of depression you may have. Whatever the cause, treatment can make you feel better, be more productive, and be better able to overcome whatever other health problems you might have.

RESOURCES

American Psychiatric Association
http://www.psych.org

US Food and Drug Administration
http://www.fda.gov

Sources

Bender, K. New warning of depression with Accutane could apply to other medications. Psychiatric Times . 1998;15:1-7.

National Institute of Mental Health website Available at: http://www.nih.gov/ .

Some drugs that cause psychiatric symptoms. Medical Letter. 1998;40:21-24.

USP DI. 21st ed. Micromedex; 2001.

Beers MH, Passman LJ. Antihypertensive medications and depression. Drugs. 1990;40(6):792-799.

Kotlyar M, Dysken M, Adson DE. Update on drug-induced depression in the elderly. Am J Geriatr Pharmacother. 2005;3(4):288-300.

Patten SB, Barbui C. Drug-induced depression: a systematic review to inform clinical practice. Psychother Psychosom. 2004;73(4):207-215.



Last reviewed January 2007 by Lawrence Frisch, MD, MPH

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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