sad and depressed young woman crying

Most people experience sadness or depression sometime during their lives. Divorce, the death of a loved one, work-related problems or financial setbacks can all trigger severe depression. Once the crisis is over, though, most people recover their equilibrium. Other people, though, suffer severe depression for no apparent reason. Sometimes antidepressant medication helps, but not always. Rarely do health professionals consider the possibility that drugs they have prescribed might be causing psychological distress.

When Drugs Cause Severe Depression?

Drug side effects pose a dilemma for doctors. On the one hand they are encouraged to “first do no harm.” But all medications have the potential to cause complications.

It is neither practical nor desirable to warn patients about every potential adverse reaction. That’s why physicians have to be selective in choosing which information they share with patients.

New research suggests, however, that health professionals may need to be more attentive to an often-ignored drug side effect: severe depression.

Hundreds of Meds Can Trigger Depression:

Investigators analyzed data from more than 26,000 adults who participated in the National Health and Nutrition Examination Survey between 2005 and 2014 (JAMA, June 12, 2018).  The volunteers filled out questionnaires designed to reveal depression and also answered detailed questions about medication use within the preceding month.

As part of the analysis, the researchers used a pharmaceutical database to identify medicines that have depression, suicide or suicidal thoughts listed as common or serious complications. Statistical analyses determined any association between the score on the depression questionnaire and the pharmaceuticals people were taking.

Scary Results: Severe Drug-Induced Depression

The results were shocking. Approximately seven percent of the people taking just one drug that could trigger depression reported mood disorders. Over 15 percent of those who were taking three or more drugs with this possible side effect experienced depression.

The authors note that:

“Adults in the United States reported use of more than 200 medications that have been associated with depression or suicidal symptoms as adverse effects.”

You might be surprised to learn that some of the most common include blood pressure medicines, acid-suppressing drugs, pain relievers and birth control pills.

Over-The-Counter Drugs and Depression:

Most of these drugs are prescribed, but some are available over the counter. Proton pump inhibitors, for example, such as esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) may all trigger symptoms of depression.

So can the emergency contraceptive levonorgestrel (Plan B). Unfortunately, OTC drug labels contain little information about depression as a side effect.

Are Patients Informed About Drug-Induced Depression?

Even when people take prescription medicines, they may not get information about side effects.

One reader wrote:

“I took the beta blocker propranolol a couple of years ago to slow my heart rate down. The medication worked, but after a week or so I started to sleep more, wanted to be alone and lost interest in cooking and eating.

“I work from home and my job is challenging and exciting. However, after few weeks I didn’t care if there were orders to process and I didn’t want to communicate with customers. I had to force myself to do things that normally I can’t wait to wake up and start my day doing.

“After six months I was really depressed. I spoke to my cardiologist’s nurse, but she said that depression was highly unlikely as a side effect. She said I could safely stop taking propranolol because I was on a very small dose. I skipped a pill for a day and felt like a dark cloud started to lift. I felt happy.

“When I went to my cardiologist and told him what had happened, he said that depression is a very common side effect of beta blockers. Really? Why was that too hard to mention before he put me on it?”

Commonly Taken Meds and Depression:

An NPR report (June 12, 2018) describes it this way:

“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.”

Drugs The Investigators Looked At:

There are hundreds of medications that can affect the mood. Some of the drugs that were on the investigators list included:

Drugs That Can Cause Depression

  • Alprazolam
  • Atenolol
  • Bupropion
  • Corticosteroids such as predinisone
  • Cyclobenzaprine
  • Diazepam
  • Duloxetine
  • Enalapril
  • Esomeprazole
  • Estradiol
  • Ethinyl estradiol
  • Finasteride
  • Fluoxetine
  • Gabapentin
  • Lamotrigine
  • Lorazepam
  • Metoprolol
  • Omeprazole
  • Paroxetine
  • Quinapril
  • Topiramate
  • Tramadol
  • Trazodone
  • Venlafaxine
  • Zolpidem

No one should ever stop any medicine without careful consultation with the prescriber. Some of these drugs are absolutely essential and it may not be appropriate to stop, even if depression is a side effect. That said, let your physician know if you experience severe depression as a side effect. An alternative medication may be feasible.

A Close Call with Heartburn Medicine:

Many years ago a reader shared this experience:

“I was stopped at an intersection on an icy day waiting for a sand truck to pass when I almost pulled out in front of him–intentionally.

“When I saw the young man’s face, I said to myself, ‘I cannot do this to him.’ After the truck passed and I drove on, I wondered what in the world was going on. I was not depressed.

“When I arrived home, I was still shaken from what I had almost done. I read the daily newspaper while I ate lunch. The first article in your column that day was from a lady whose husband had committed suicide while taking metoclopramide (Reglan).

“That was the exact same medication my doctor had prescribed for my stomach. I jumped up and emptied that bottle down the toilet and wrote on it in large letters, DO NOT TAKE AGAIN. I thank God and the lady who wrote you that letter.”

Metoclopramide carries a warning that it can cause mental depression and suicidal ideation. Patients should always be cautioned about such a serious complication.

Sometimes a medicine is essential, and any psychological reactions it causes can be handled with another medication. But often, rather than piling one drug with potential side effects up on top of another, it makes sense to re-evaluate the original treatment.

Full Information About Drugs and Severe Depression!

Health professionals must alert their patients about the potential for drug-induced severe depression as a side effect. This is particularly true if people are taking more than one medication.

Please share your own experience with drugs and depression in the comment section below.

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  1. Bsrn
    Waterford mi
    Reply

    I take Prilosec, and with doctors advice continue taking 1 per day. I am in big trouble without it. I
    have had some depression symptoms. I have had some injuries lately and have been taking 600 mg of ibuprofen before bed. Well. After reading above info, I quit the ibuprofen. Depression lifted within 2 days. Hurrah. NOW. What can I take for pain??! Any help out there??

  2. Joy
    Miami,Fl.
    Reply

    Our local Walgreen drugstore has a bin at the pharmacy to dispose of unused medicine. I’m sure that they will dispose of them properly

  3. janet
    Arizona
    Reply

    Hello – this morning on CBS there was a segment which stated that the drug “Valsartan” made in China could trigger cancer, and since I have been taking this drug for years and this past fall had to undergo surgery for breast cancer. I was alarmed.

    Do you have any info on the subject ?

    Sincerely,

    • Terry Graedon
      Reply

      Sandoz valsartan and Sandoz valsartan/hydrochlorothiazide are being recalled in 22 countries, mostly in Europe, because they were contaminated with N-Nitrosodimethylamine (NDMA), a potential carcinogen. It is not clear that this problem affects valsartan being sold in the US. We’ll let you know more as we learn more.

  4. Laure
    Michigan
    Reply

    Fluoxetine is on the list of drugs that can cause depression. I’ve been on it for over 30 years FOR MDD. It doesn’t really work. Is it making things worse?

    • LI
      Reply

      My concern here is that you have apparently been taking a drug, fluoxetine, for over 30 years for Major Depressive Disorder that you state “doesn’t really work.”

      There are many medications for the treatment of depression; some are SSRI’s like fluoxetine, and others are not. The real question here is not whether the fluoxetine is making your depression worse, but why you have not explored other medication options with your physician to find one that does work.

  5. Helen Blyshak
    North Carolina
    Reply

    I feel Drs are passing out these drugs, because it’s the easy way out…. they have genetic testing and they won’t do it. Why???? I take alprazolam and I hate it.

    It’s short-term help and makes you feel terrible like you always have a hangover, my next trip to Dr is going to get me off this nasty stuff. I have never felt so low in my life. Bad pill, most all anti-depressants are unhealthy and make your depression worse.

    • LI
      Reply

      I’m sorry you are having such a difficult time with alprazolam (Xanax). Despite all the hype about genetic testing and personalized medicine, we are a very long way from being able to pinpoint which psychotropic medications will work best with each patient. So, trial and error continues.

      Your statement that “most all anti-depressants…make your depression worse” is not one that is supported by research (see https://sciencebasedmedicine.org/the-debate-is-over-antidepressants-do-work-better-than-placebo/) , and is not supported by your unfortunate experience with alprazolam. Alprazolam is a benzodiazepine, a type of drug which is generally prescribed for anxiety, including the anxiety that may accompany certain forms of depression. It is not technically, however, an anti-depressant.

  6. Marty
    Ct.
    Reply

    I’m very concerned….Bupropion is an antidepressant medication and it’s on this list.

    My doctor recently increased my dose of bupropion and I noticed symptoms indicative of worse depression almost immediately. I’m going to talk to my doctor and go back to the lower dose.

  7. Sylvia R
    VA
    Reply

    Had severe depression when taking Valium, beware of that one. Took me a very long time to defeat it after I quit the drug.

    No one told me it could cause depression, was told it was like a strong aspirin. If I had known I would not have taken it!

  8. Chetyl
    Massachusetts
    Reply

    Do not ever flush medications down the toilet, it is irresponsible to our fish and environment. Bring them to a local Pharmacy such as Walgreens or pound them to a fine dust in a freezer bag and then mix with something like coffee grounds then put in your trash.

  9. Abigail
    USA
    Reply

    I’m wondering if some of the symptoms of depression can be dismissed or mistaken for something else. Please add to this important column the depression symptoms we should be aware of.

  10. Crazyhorse
    Indiana
    Reply

    Timolol eye drops for glaucoma precipitated signs of clinical depression. That was the last source I considered before discontinuing them and disengaging from the ophthalmologist who prescribed them and who was unresponsive to my distress.

  11. mary
    Reply

    As usual, an article that needs to be shared with many. Thank you.
    However, drugs should never be flushed down the toilet. That was the old medical recommendation before realizing drugs enter the water supply we all drink. There are drug collection days in many towns regularly for drugs out of date, unused, or needing to be disposed of for any reason. I have just learned that the police station here has a bin in the lobby for that purpose. No, I do not know how they are disposed of and if it is safe, but hopeful.

    So many drugs are excreted in urine and never able to be filtered out of our water. Affecting us all. Please do not add to that amount. Thank you.

  12. Larry M
    Raleigh, NC
    Reply

    Not a prescription drug, but caffeine in excess is a depressant, too. If the cause is unknown, it cannot hurt to quit it. Taper off over a period of three days or so to avoid headaches and expect results after six weeks or so.

  13. Patricia
    Reply

    Antibiotics should also be considered as possible causes of depression – I took ciprofloxacin for a UTI and plunged into misery. Only after researching online did I discover that depression is a recognised unwanted effect of this drug. Who would have thought? I had tried many, many natural ways to get rid of the UTI without success but if I get another one I’ll live with it.

    • Deni
      South Florida
      Reply

      @Patricia, RE ciprofloxacin:
      I wish more people knew about the devastating dangers of fluoroquinolones, the class of antibiotics that ciprofloxacin belongs to.

      To anyone reading this, I would strongly urge you to acquaint yourself with the different antibiotic names in this family of drugs called fluoroquinolones. Levaquin, Cipro, and Ciprofloxacin are but a few of the names.

      Please do research on this family of drugs; depression is but one of the damages it does. Fluoroquinolones attack the nervous system and connective tissue. The damage can be permanent, although some have arrested the avalanche of destruction by taking very high doses of magnesium, among other supplements.

      I first became acquainted with Cipro, and this family of drugs, when my then-alive mother had one of her bicep tendons rip off of her left humerus back in 2004. Through the years I have met people whose Achilles tendon would inexplicably tear while on a fluoroquinolone. A good friend had cruciate ligament damage resulting from this drug.

      PLEASE, look up websites and blogs dedicated to this topic telling the personal stories of individuals who lost the quality of their lives after just a short time on fluoroquinolones — often in the prime of their lives when a simple infection was treated with this drug. But, brace yourselves, the stories read like tragic horror stories. Depression is but one of the many damages this class of drugs inflicts on otherwise healthy people treating a simple infection.

      I am not anti-antibiotics; they have their place in medicine and we’re fortunate to have them. But, please convince your dr to write a different Rx that is not a fluoroquinolone.

      To better health, and educating our doctors.

    • LI
      Reply

      Yes, depression is a potential, albeit rare, side effect of ciprofloxacin. However, ciprofloxacin is not the only antibiotic prescribed for UTI’s. Others can be used, such as ampicillin, Macrobid, Keflex, Bactrim, etc. Perhaps you should talk to your physician about another option.

  14. Sue
    Maryland
    Reply

    I got depressed when I took Pepcid or Zantac for heartburn and reflux. Those are H2 agonists I believe. Interestingly, the proton pump inhibitors did not make me depressed.

  15. john
    GA
    Reply

    Thanks for all this very important information. Medications & their side effects & interactions are increasingly mysterious & complicated. Advice from a friend with a serious, chronic, & ultimately-fatal illness: “I must think of myself as one of my doctors & responsible for sharing my care with my other doctors. It’s my only hope for survival.”

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