Depression and suicide risk are side effects of more than 200 common drugs

The recent suicides of celebrities Anthony Bourdain and Kate Spade have prompted many of us to look more closely at what may drive people to depression or to end their own lives.

One risk factor has gotten little attention in this discussion: the medications people take.

More than a third of American adults are using medications that have the potential to increase their risk of depression, a study published this week in JAMA finds, and nearly a quarter use medications that have suicidal symptoms as side effects.

The 203 drugs the researchers identified aren’t obscure; they include some of the most commonly prescribed medications around — like birth control, beta-blockers for high blood pressure, and proton pump inhibitors for acid reflux. (You can see the full list at the end of this article.)

Strikingly, the researchers from the University of Illinois and Columbia University discovered, people using these drugs had an elevated risk of depression compared to the general population. And the more medications with depression as a side effect people took, the more their risk of the disease increased.

Depression and suicide risk are side effects of more than 200 common drugs

“It’s remarkable to know just how common it is that people might be at higher risk because of medicines they take,” said University of Pennsylvania psychiatry professor Michael Thase, who was not involved in the study. “Thinking about these [potential side effects] should be [doctors‘] second or third step before they prescribe antidepressants. Sometimes de-prescribing [other drugs] is what’s needed.”

Since depression affects more than one in 20 adults in the US every year, and suicide rates have been steadily climbing here for years, these new findings are an important reminder that the drugs a person takes for one health condition may be making them sick in other ways.

Americans commonly use more than 200 drugs that carry depression or suicidal symptoms as side effects

Every medication comes with many possible side effects, and most of those side effects are rare. (Just think about the warnings highlighted on the drug commercials on TV.) If a side effect is listed on a package insert, it generally means at least 1 to 2 percent of people will experience it, said lead study author Dima Mazen Qato, a pharmacist and assistant professor of pharmacy at the University of Illinois Chicago.

To figure out how common depression and suicide-related symptoms (including suicide, or suicidal thoughts and behaviors) side effects were among the drugs Americans take, the researchers turned to the National Health and Nutrition Examination Survey, a government-run study that’s been tracking health trends in a representative sample of Americans since the 1970s.

If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, there are people who want to help:

In the US:

Crisis Text Line: Text START to 741741 from anywhere in the USA, at any time, about any type of crisis

The National Suicide Prevention Lifeline: 1-800-273-8255

The Trevor Project: 1-866-488-7386

Outside the US:

The International Association for Suicide Prevention lists a number of suicide hotlines by country. Click here to find them.

Befrienders Worldwide

They combed through the drug-use data on more than 26,000 people who participated in the study between 2005 and 2014 and found that Americans reported using 203 medications with depression and suicidal symptoms listed among their side effects. As of 2013 to 2014, 38 percent of adults reported taking drugs with depression as a potential side effect within the past 30 days, while 23 percent were using drugs that carried the risk of suicidal symptoms.

After the researchers figured out that these drugs were common, they wanted to see if there was any relationship between the people taking the drugs and an elevated risk of depression. To find this out, they turned to the NHANES survey again, which also tracks mental health. They discovered that the more drugs people reported taking, the higher their risk of depression and suicide.

There was a tripling of depression risk among people on three or more medications that have depression as a potential side effect

To get a sense for how much of a risk of depression and suicide taking these drugs were associated with, let’s walk through the numbers.

In the total study population of more than 23,000 people (excluding the people on antidepressants) 6 percent reported depression. Among the users of just one of the drugs that have depression as an adverse effect, the prevalence increased to 7 percent. Among people taking two or more of the potentially depression-inducing drugs, the prevalence shot up to 10 percent. And among people taking three or more of the drugs, the prevalence was 15 percent. (Again, for all these figures, the researchers excluded antidepressant users since they’d inflate the results.)

They found similar associations in non-antidepressant users who were taking medications with suicide symptoms. In the total study population, who weren‘t using medications with suicidal symptoms, five percent of participants reported suicidal symptoms. Among adults on one of these medications, the prevalence rose to 8 percent and among adults using three or more, the prevalence jumped to 18 percent.

“One can say you’d expect that finding because people who have more medical problems are more likely to take more medications and are more likely to be depressed,” said study co-author Mark Olfson, a professor of epidemiology and psychiatry at the Columbia University Medical Center.

But when the researchers looked at drugs that weren’t associated with depressive side effects, they found no dose-response like the one they discovered in people taking one or more drugs with depressive or suicidal side effects. In other words, simply taking more medications, when the medications don‘t have depression or suicide listed as a side effect, was not associated with an increased risk.

“It didn’t surprise me that there are a large numbers of drugs [with these side effects] and that these drugs are commonly prescribed,” said Olfson. “But what surprised me is that you can see this connection [to depression] in the general population, how strong it was, and that it builds up with each additional medication a person uses.”

Penn’s Thase called the findings “very suggestive” and ”strong circumstantial evidence” that taking one or more medications with depression as a potential side effect may increase a person’s risk of depression. While these medications work through different mechanisms, he said, it’s possible that when they‘re combined, those risks increase.

While the researchers did their best to statistically control for factors that may confound their results, like sex, age, race, and employment status, there were some things the paper can’t tell us.

Because this is an observational study and not an experimental study, the researchers stopped short of saying the medications caused the depression. To find that out, they’d need to do a follow-up study where they track people who start taking these medications over time and see if their risk of depression increases.

What’s more, there are many factors that can increase a person’s risk of depression and suicide, including one’s personal and family medical history and major life upheavals, and the researchers couldn‘t account for those. The sample in the study was also too small to drill down into the individual medications and their depression patterns.

But for now, the study is a powerful reminder that people know that certain medications carry the risk of depression and suicidal thinking, and that they should talk to their doctors about that when starting on a new drug.

“When you have a patient,“ said Penn‘s Thase, “and their story doesn’t fit the usual pattern — there are no setbacks in the person‘s life, no broken heart, no job difficulty, [doctors] should think of other possible masquerading causes — and the chance that medication could be the cause.”

For patients concerned about the side effects of their medications, this database from the National Institutes of Health lets you search for the side effects for most drugs and drug classes. We’ve also created a table of the 203 drugs the researchers found that had depression or suicidal symptoms as side effects:

Drugs with depression and suicide risks

NameTypeRisk
NameTypeRisk
Abacavir/LamivudineOtherDepressive Symptoms
AcebutololOtherDepressive Symptoms
Acetaminophen/HydrocodoneAnalgesicsDepressive Symptoms
Acetaminophen/TramadolAnalgesicSuicidal Symptoms
AcitretinOtherDepressive Symptoms
AmantadineOtherSuicidal Symptoms
AmitriptylineAntidepressantSuicidal Symptoms
Amitriptyline/ChlordiazepoxideAntidepressantSuicidal Symptoms
Amitriptyline/PerphenazineAntidepressantSuicidal Symptoms
Amphetamine/DetroamphetamineOtherDepressive Symptoms
AnastrozoleHormone ModifiersDepressive Symptoms
AripiprazoleOtherSuicidal Symptoms
ArmodafinilOtherSuicidal Symptoms
AsenapineOtherSuicidal Symptoms
AtenololAntihypertensivesDepressive Symptoms
Atenolol/ChlorthalidoneAntihypertensivesDepressive Symptoms
AtomoxetineOtherSuicidal Symptoms
Atropine/DiphenoxylateGastrointestinal AgentsDepressive Symptoms
BaclofenOtherDepressive Symptoms
Bendroflumethiazide/NadololAntihypertensivesDepressive Symptoms
BenzphetamineOtherDepressive Symptoms
BetamethasoneCorticosteroidsDepressive Symptoms
BetaxololAntihypertensivesDepressive Symptoms
BicalutamideHormone ModifiersDepressive Symptoms
BrimonidineAntihypertensivesDepressive Symptoms
Brimonidine/TimololAntihypertensivesDepressive Symptoms
BupropionAntidepressantSuicidal Symptoms
ButabarbitalAnxiolyticSuicidal Symptoms
CabergolineHormone ModifiersDepressive Symptoms
Carbamazepine ClonazepamAnticonvulsantSuicidal Symptoms
Carbidopa/Entacapone/LevodopaOtherSuicidal Symptoms
Carbidopa/LevodopaOtherSuicidal Symptoms
Cetirizine6
Respiratory AgentDepressive Symptoms
ChlordiazepoxideAnxiolyticSuicidal Symptoms
CimetidineGastrointestinal AgentsDepressive Symptoms
CinacalcetOtherDepressive Symptoms
CiprofloxacinOtherSuicidal Symptoms
CitalopramAntidepressantSuicidal Symptoms
ClomipramineAntidepressantSuicidal Symptoms
ClonazepamAnxiolyticSuicidal Symptoms
ClonidineOtherDepressive Symptoms
ClorazepateAnxiolyticSuicidal Symptoms
Conjugated EstrogensHormone ModifiersDepressive Symptoms
Conjugated Estrogens/MedroxyprogesteroneHormone ModifiersDepressive Symptoms
CortisoneCorticosteroidsDepressive Symptoms
CyclobenzaprineAnalgesicsDepressive Symptoms
CyclosporineOtherDepressive Symptoms
DantroleneOtherDepressive Symptoms
DapsoneOtherSuicidal Symptoms
DesipramineAntidepressantSuicidal Symptoms
Desogestrel/Ethinyl EstradiolHormone ModifiersDepressive Symptoms
DesvenlafaxineAntidepressantSuicidal Symptoms
DexamethasoneCorticosteroidsDepressive Symptoms
DexlansoprazoleGastrointestinal AgentsDepressive Symptoms
DexmethylphenidateOtherDepressive Symptoms
DiazepamAnticonvulsantSuicidal Symptoms
DiazepamAnxiolyticSuicidal Symptoms
Dienogest/EstradiolHormone ModifiersDepressive Symptoms
DonepezilOtherDepressive Symptoms
Dorzolamide/TimololAntihypertensivesDepressive Symptoms
DoxepinAntidepressantSuicidal Symptoms
DoxepinAnxiolyticSuicidal Symptoms
DronabinolOtherDepressive Symptoms
Drospirenone/Ethinyl EstradiolHormone ModifiersDepressive Symptoms
Drospirenone/Ethinyl Estradiol/LevomefolateHormone ModifiersDepressive Symptoms
DuloxetineAntidepressantSuicidal Symptoms
EfavirenzOtherSuicidal Symptoms
Efavirenz/Emtricitabine/TenofovirOtherSuicidal Symptoms
EmtricitabineOtherDepressive Symptoms
EnalaprilAntihypertensivesDepressive Symptoms
ErlotinibOtherDepressive Symptoms
EscitalopramAntidepressantSuicidal Symptoms
EsomeprazoleGastrointestinal AgentsDepressive Symptoms
Esterified EstrogensHormone ModifiersDepressive Symptoms
Esterified Estrogens/MethyltestosteroneHormone ModifiersDepressive Symptoms
EstradiolHormone ModifiersDepressive Symptoms
Estradiol/NorethindroneHormone ModifiersDepressive Symptoms
EstropipateHormone ModifiersDepressive Symptoms
EszopicloneAnxiolyticSuicidal Symptoms
Ethinyl Estradiol/EthynodiolHormone ModifiersDepressive Symptoms
Ethinyl Estradiol/EtonogestrelHormone ModifiersDepressive Symptoms
Ethinyl Estradiol/LevonorgestrelHormone ModifiersDepressive Symptoms
Ethinyl Estradiol/NorethindroneHormone ModifiersDepressive Symptoms
Ethinyl Estradiol/NorgestimateHormone ModifiersDepressive Symptoms
Ethinyl Estradiol/NorgestrelHormone ModifiersDepressive Symptoms
EthosuximideAnticonvulsantSuicidal Symptoms
EtonogestrelHormone ModifiersDepressive Symptoms
ExemestaneHormone ModifiersDepressive Symptoms
FamotidineGastrointestinal AgentsDepressive Symptoms
FentanylAnalgesicsDepressive Symptoms
FlecainideOtherDepressive Symptoms
FluoxetineAntidepressantSuicidal Symptoms
Fluoxetine/OlanzapineAntidepressantSuicidal Symptoms
Fluphenazine7OtherDepressive Symptoms
FlurazepamAnxiolyticSuicidal Symptoms
FluvoxamineAntidepressantSuicidal Symptoms
GabapentinAnticonvulsantSuicidal Symptoms
GalantamineOtherDepressive Symptoms
GoserelinHormone ModifiersDepressive Symptoms
HaloperidolOtherDepressive Symptoms
Hydrochlorothiazide/MetoprololAntihypertensivesDepressive Symptoms
HydrocodoneAntihypertensivesDepressive Symptoms
HydropmorphoneAnalgesicSuicidal Symptoms
HydroxyprogesteroneHormone ModifiersDepressive Symptoms
IbuprofenAnalgesicsDepressive Symptoms
IloperidoneOtherSuicidal Symptoms
ImipramineAntidepressantSuicidal Symptoms
IndomethacinAnalgesicsDepressive Symptoms
Interferon Beta-1aOtherSuicidal Symptoms
Interferon Beta-1bOtherSuicidal Symptoms
IsotretinoinOtherSuicidal Symptoms
LamotrigineAnticonvulsantSuicidal Symptoms
LevetiracetamAnticonvulsantSuicidal Symptoms
LorazepamAnticonvulsantSuicidal Symptoms
LurasidoneOtherSuicidal Symptoms
MaravirocOtherDepressive Symptoms
MedroxyprogesteroneHormone ModifiersDepressive Symptoms
MefloquineOtherSuicidal Symptoms
MegestrolHormone ModifiersDepressive Symptoms
MemantineOtherSuicidal Symptoms
MethsuximideAnticonvulsantSuicidal Symptoms
MethyldopaOtherDepressive Symptoms
MethylphenidateOtherSuicidal Symptoms
MethylprednisoloneCorticosteroidsDepressive Symptoms
MetoclopramideGastrointestinal AgentSuicidal Symptoms
MetolazoneAntihypertensivesDepressive Symptoms
MetolazoneOtherDepressive Symptoms
MetoprololAntihypertensivesDepressive Symptoms
MetronidazoleOtherDepressive Symptoms
MilnacipranAntidepressantSuicidal Symptoms
MirtazapineAntidepressantSuicidal Symptoms
ModafinilOtherSuicidal Symptoms
MorphineAnalgesicsDepressive Symptoms
MoxifloxacinOtherSuicidal Symptoms
NabumetoneAnalgesicsDepressive Symptoms
NaltrexoneOtherSuicidal Symptoms
NatalizumabOtherSuicidal Symptoms
NefazodoneAntidepressantSuicidal Symptoms
NisoldipineAntihypertensivesDepressive Symptoms
NorethindroneHormone ModifiersDepressive Symptoms
NortriptylineAntidepressantSuicidal Symptoms
OfloxacinOtherSuicidal Symptoms
OlanzapineOtherSuicidal Symptoms
OmeprazoleGastrointestinal AgentsDepressive Symptoms
OxcarbazepineAnticonvulsantSuicidal Symptoms
Oxybutynin8OtherDepressive Symptoms
OxycodoneAnalgesicsDepressive Symptoms
ParoxetineAntidepressantSuicidal Symptoms
Peginterferon Alfa-2aOtherSuicidal Symptoms
PentobarbitalAnxiolyticSuicidal Symptoms
PhenelzineAntidepressantSuicidal Symptoms
Phentermine9OtherDepressive Symptoms
PhenytoinAnticonvulsantSuicidal Symptoms
PimozideOtherDepressive Symptoms
PrazosinOtherDepressive Symptoms
PrednisoloneCorticosteroidsDepressive Symptoms
PrednisoneCorticosteroidsDepressive Symptoms
PregabalinAnticonvulsantSuicidal Symptoms
PropafenoneOtherDepressive Symptoms
PropranololOtherDepressive Symptoms
ProtriptylineAntidepressantSuicidal Symptoms
QuetiapineOtherSuicidal Symptoms
QuinaprilAntihypertensivesDepressive Symptoms
RaltegravirOtherSuicidal Symptoms
RamelteonAnxiolyticSuicidal Symptoms
RanitidineGastrointestinal AgentsDepressive Symptoms
RasagilineOtherDepressive Symptoms
RibavirinRespiratory AgentSuicidal Symptoms
Risperidone4OtherSuicidal Symptoms
Rivastigmine5OtherSuicidal Symptoms
RoflumilastRespiratory AgentSuicidal Symptoms
RotigotineOtherDepressive Symptoms
SelegilineAntidepressantSuicidal Symptoms
SertralineAntidepressantSuicidal Symptoms
SibutramineOtherSuicidal Symptoms
SorafenibOtherDepressive Symptoms
TamoxifenHormone ModifiersDepressive Symptoms
TapentadolAnalgesicSuicidal Symptoms
TelmisartanAntihypertensivesDepressive Symptoms
TestosteroneHormone ModifiersDepressive Symptoms
TetrabenazineOtherSuicidal Symptoms
TimololAntihypertensivesDepressive Symptoms
TizanidineOtherDepressive Symptoms
TopiramateAnticonvulsantSuicidal Symptoms
TramadolAnalgesicSuicidal Symptoms
TrandolaprilAntihypertensivesDepressive Symptoms
TrazodoneAntidepressantSuicidal Symptoms
TriamcinoloneCorticosteroidsDepressive Symptoms
TriazolamAnxiolyticSuicidal Symptoms
Valproic AcidAnticonvulsantSuicidal Symptoms
VareniclineOtherSuicidal Symptoms
VenlafaxineAntidepressantSuicidal Symptoms
VilazodoneAntidepressantSuicidal Symptoms
Zafirlukast3Respiratory AgentSuicidal Symptoms
ZaleplonAnxiolyticSuicidal Symptoms
ZolpidemAnxiolyticSuicidal Symptoms
ZonisamideAnticonvulsantSuicidal Symptoms

Sourse: breakingnews.ie

Depression and suicide risk are side effects of more than 200 common drugs

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