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


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

Name Type Risk
Name Type Risk
Abacavir/Lamivudine Other Depressive Symptoms
Acebutolol Other Depressive Symptoms
Acetaminophen/Hydrocodone Analgesics Depressive Symptoms
Acetaminophen/Tramadol Analgesic Suicidal Symptoms
Acitretin Other Depressive Symptoms
Amantadine Other Suicidal Symptoms
Amitriptyline Antidepressant Suicidal Symptoms
Amitriptyline/Chlordiazepoxide Antidepressant Suicidal Symptoms
Amitriptyline/Perphenazine Antidepressant Suicidal Symptoms
Amphetamine/Detroamphetamine Other Depressive Symptoms
Anastrozole Hormone Modifiers Depressive Symptoms
Aripiprazole Other Suicidal Symptoms
Armodafinil Other Suicidal Symptoms
Asenapine Other Suicidal Symptoms
Atenolol Antihypertensives Depressive Symptoms
Atenolol/Chlorthalidone Antihypertensives Depressive Symptoms
Atomoxetine Other Suicidal Symptoms
Atropine/Diphenoxylate Gastrointestinal Agents Depressive Symptoms
Baclofen Other Depressive Symptoms
Bendroflumethiazide/Nadolol Antihypertensives Depressive Symptoms
Benzphetamine Other Depressive Symptoms
Betamethasone Corticosteroids Depressive Symptoms
Betaxolol Antihypertensives Depressive Symptoms
Bicalutamide Hormone Modifiers Depressive Symptoms
Brimonidine Antihypertensives Depressive Symptoms
Brimonidine/Timolol Antihypertensives Depressive Symptoms
Bupropion Antidepressant Suicidal Symptoms
Butabarbital Anxiolytic Suicidal Symptoms
Cabergoline Hormone Modifiers Depressive Symptoms
Carbamazepine Clonazepam Anticonvulsant Suicidal Symptoms
Carbidopa/Entacapone/Levodopa Other Suicidal Symptoms
Carbidopa/Levodopa Other Suicidal Symptoms
Respiratory Agent Depressive Symptoms
Chlordiazepoxide Anxiolytic Suicidal Symptoms
Cimetidine Gastrointestinal Agents Depressive Symptoms
Cinacalcet Other Depressive Symptoms
Ciprofloxacin Other Suicidal Symptoms
Citalopram Antidepressant Suicidal Symptoms
Clomipramine Antidepressant Suicidal Symptoms
Clonazepam Anxiolytic Suicidal Symptoms
Clonidine Other Depressive Symptoms
Clorazepate Anxiolytic Suicidal Symptoms
Conjugated Estrogens Hormone Modifiers Depressive Symptoms
Conjugated Estrogens/Medroxyprogesterone Hormone Modifiers Depressive Symptoms
Cortisone Corticosteroids Depressive Symptoms
Cyclobenzaprine Analgesics Depressive Symptoms
Cyclosporine Other Depressive Symptoms
Dantrolene Other Depressive Symptoms
Dapsone Other Suicidal Symptoms
Desipramine Antidepressant Suicidal Symptoms
Desogestrel/Ethinyl Estradiol Hormone Modifiers Depressive Symptoms
Desvenlafaxine Antidepressant Suicidal Symptoms
Dexamethasone Corticosteroids Depressive Symptoms
Dexlansoprazole Gastrointestinal Agents Depressive Symptoms
Dexmethylphenidate Other Depressive Symptoms
Diazepam Anticonvulsant Suicidal Symptoms
Diazepam Anxiolytic Suicidal Symptoms
Dienogest/Estradiol Hormone Modifiers Depressive Symptoms
Donepezil Other Depressive Symptoms
Dorzolamide/Timolol Antihypertensives Depressive Symptoms
Doxepin Antidepressant Suicidal Symptoms
Doxepin Anxiolytic Suicidal Symptoms
Dronabinol Other Depressive Symptoms
Drospirenone/Ethinyl Estradiol Hormone Modifiers Depressive Symptoms
Drospirenone/Ethinyl Estradiol/Levomefolate Hormone Modifiers Depressive Symptoms
Duloxetine Antidepressant Suicidal Symptoms
Efavirenz Other Suicidal Symptoms
Efavirenz/Emtricitabine/Tenofovir Other Suicidal Symptoms
Emtricitabine Other Depressive Symptoms
Enalapril Antihypertensives Depressive Symptoms
Erlotinib Other Depressive Symptoms
Escitalopram Antidepressant Suicidal Symptoms
Esomeprazole Gastrointestinal Agents Depressive Symptoms
Esterified Estrogens Hormone Modifiers Depressive Symptoms
Esterified Estrogens/Methyltestosterone Hormone Modifiers Depressive Symptoms
Estradiol Hormone Modifiers Depressive Symptoms
Estradiol/Norethindrone Hormone Modifiers Depressive Symptoms
Estropipate Hormone Modifiers Depressive Symptoms
Eszopiclone Anxiolytic Suicidal Symptoms
Ethinyl Estradiol/Ethynodiol Hormone Modifiers Depressive Symptoms
Ethinyl Estradiol/Etonogestrel Hormone Modifiers Depressive Symptoms
Ethinyl Estradiol/Levonorgestrel Hormone Modifiers Depressive Symptoms
Ethinyl Estradiol/Norethindrone Hormone Modifiers Depressive Symptoms
Ethinyl Estradiol/Norgestimate Hormone Modifiers Depressive Symptoms
Ethinyl Estradiol/Norgestrel Hormone Modifiers Depressive Symptoms
Ethosuximide Anticonvulsant Suicidal Symptoms
Etonogestrel Hormone Modifiers Depressive Symptoms
Exemestane Hormone Modifiers Depressive Symptoms
Famotidine Gastrointestinal Agents Depressive Symptoms
Fentanyl Analgesics Depressive Symptoms
Flecainide Other Depressive Symptoms
Fluoxetine Antidepressant Suicidal Symptoms
Fluoxetine/Olanzapine Antidepressant Suicidal Symptoms
Fluphenazine7 Other Depressive Symptoms
Flurazepam Anxiolytic Suicidal Symptoms
Fluvoxamine Antidepressant Suicidal Symptoms
Gabapentin Anticonvulsant Suicidal Symptoms
Galantamine Other Depressive Symptoms
Goserelin Hormone Modifiers Depressive Symptoms
Haloperidol Other Depressive Symptoms
Hydrochlorothiazide/Metoprolol Antihypertensives Depressive Symptoms
Hydrocodone Antihypertensives Depressive Symptoms
Hydropmorphone Analgesic Suicidal Symptoms
Hydroxyprogesterone Hormone Modifiers Depressive Symptoms
Ibuprofen Analgesics Depressive Symptoms
Iloperidone Other Suicidal Symptoms
Imipramine Antidepressant Suicidal Symptoms
Indomethacin Analgesics Depressive Symptoms
Interferon Beta-1a Other Suicidal Symptoms
Interferon Beta-1b Other Suicidal Symptoms
Isotretinoin Other Suicidal Symptoms
Lamotrigine Anticonvulsant Suicidal Symptoms
Levetiracetam Anticonvulsant Suicidal Symptoms
Lorazepam Anticonvulsant Suicidal Symptoms
Lurasidone Other Suicidal Symptoms
Maraviroc Other Depressive Symptoms
Medroxyprogesterone Hormone Modifiers Depressive Symptoms
Mefloquine Other Suicidal Symptoms
Megestrol Hormone Modifiers Depressive Symptoms
Memantine Other Suicidal Symptoms
Methsuximide Anticonvulsant Suicidal Symptoms
Methyldopa Other Depressive Symptoms
Methylphenidate Other Suicidal Symptoms
Methylprednisolone Corticosteroids Depressive Symptoms
Metoclopramide Gastrointestinal Agent Suicidal Symptoms
Metolazone Antihypertensives Depressive Symptoms
Metolazone Other Depressive Symptoms
Metoprolol Antihypertensives Depressive Symptoms
Metronidazole Other Depressive Symptoms
Milnacipran Antidepressant Suicidal Symptoms
Mirtazapine Antidepressant Suicidal Symptoms
Modafinil Other Suicidal Symptoms
Morphine Analgesics Depressive Symptoms
Moxifloxacin Other Suicidal Symptoms
Nabumetone Analgesics Depressive Symptoms
Naltrexone Other Suicidal Symptoms
Natalizumab Other Suicidal Symptoms
Nefazodone Antidepressant Suicidal Symptoms
Nisoldipine Antihypertensives Depressive Symptoms
Norethindrone Hormone Modifiers Depressive Symptoms
Nortriptyline Antidepressant Suicidal Symptoms
Ofloxacin Other Suicidal Symptoms
Olanzapine Other Suicidal Symptoms
Omeprazole Gastrointestinal Agents Depressive Symptoms
Oxcarbazepine Anticonvulsant Suicidal Symptoms
Oxybutynin8 Other Depressive Symptoms
Oxycodone Analgesics Depressive Symptoms
Paroxetine Antidepressant Suicidal Symptoms
Peginterferon Alfa-2a Other Suicidal Symptoms
Pentobarbital Anxiolytic Suicidal Symptoms
Phenelzine Antidepressant Suicidal Symptoms
Phentermine9 Other Depressive Symptoms
Phenytoin Anticonvulsant Suicidal Symptoms
Pimozide Other Depressive Symptoms
Prazosin Other Depressive Symptoms
Prednisolone Corticosteroids Depressive Symptoms
Prednisone Corticosteroids Depressive Symptoms
Pregabalin Anticonvulsant Suicidal Symptoms
Propafenone Other Depressive Symptoms
Propranolol Other Depressive Symptoms
Protriptyline Antidepressant Suicidal Symptoms
Quetiapine Other Suicidal Symptoms
Quinapril Antihypertensives Depressive Symptoms
Raltegravir Other Suicidal Symptoms
Ramelteon Anxiolytic Suicidal Symptoms
Ranitidine Gastrointestinal Agents Depressive Symptoms
Rasagiline Other Depressive Symptoms
Ribavirin Respiratory Agent Suicidal Symptoms
Risperidone4 Other Suicidal Symptoms
Rivastigmine5 Other Suicidal Symptoms
Roflumilast Respiratory Agent Suicidal Symptoms
Rotigotine Other Depressive Symptoms
Selegiline Antidepressant Suicidal Symptoms
Sertraline Antidepressant Suicidal Symptoms
Sibutramine Other Suicidal Symptoms
Sorafenib Other Depressive Symptoms
Tamoxifen Hormone Modifiers Depressive Symptoms
Tapentadol Analgesic Suicidal Symptoms
Telmisartan Antihypertensives Depressive Symptoms
Testosterone Hormone Modifiers Depressive Symptoms
Tetrabenazine Other Suicidal Symptoms
Timolol Antihypertensives Depressive Symptoms
Tizanidine Other Depressive Symptoms
Topiramate Anticonvulsant Suicidal Symptoms
Tramadol Analgesic Suicidal Symptoms
Trandolapril Antihypertensives Depressive Symptoms
Trazodone Antidepressant Suicidal Symptoms
Triamcinolone Corticosteroids Depressive Symptoms
Triazolam Anxiolytic Suicidal Symptoms
Valproic Acid Anticonvulsant Suicidal Symptoms
Varenicline Other Suicidal Symptoms
Venlafaxine Antidepressant Suicidal Symptoms
Vilazodone Antidepressant Suicidal Symptoms
Zafirlukast3 Respiratory Agent Suicidal Symptoms
Zaleplon Anxiolytic Suicidal Symptoms
Zolpidem Anxiolytic Suicidal Symptoms
Zonisamide Anticonvulsant Suicidal Symptoms


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

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