Do you feel down in the dumps, sad or depressed? Have you ever considered the possibility that your medicine might be responsible for your blue mood? Health professionals rarely mention that many medications can have a profound impact on our psychological state.
More than 15 million Americans suffer depression in any given year. Not surprisingly, antidepressants like desvenlafaxine (Pristiq), duloxetine (Cymbalta), fluoxetine (Prozac), sertraline (Zoloft) and venlafaxine (Effexor) are widely prescribed.
Health professionals value these medications partly because they believe that depression is caused by chemical imbalances in the brain. Antidepressants that modify neurotransmitters such as serotonin and norepinephrine are expected to solve the problem.
How Good Are Antidepressants?
The trouble is that in many clinical trials, antidepressants are only modestly better than placebo (Cochrane Database of Systematic Reviews, Nov. 14, 2012). We recognize that for some people, an antidepressant can extremely helpful. But there is no way to know in advance if that will be the case on an individual basis. It is still pretty much trial and error as to whether a medication will help a depressed patient or cause more harm than good. The clinical trials repeatedly demonstrate that the benefits of such drugs are not as great as most patients and prescribers imagine.
Depression can be caused by many other factors including genetics, stressful life events, illness and medications. Patients are not always warned that they might experience changes in mood or become depressed as a side effect of a prescription drug.
One reader shared this experience with a beta-blocker blood pressure medicine:
“I have been on metoprolol for years. I have asked numerous doctors why I am suffering with fatigue, depression, palpitations, dizziness, difficulty breathing, coughing, cold feet and hands, lightheadedness, poor coordination and many other symptoms. When I request a change in blood pressure medicine, doctors brush me off. Am I wrong in wanting to change?”
The Beta Blocker Blues/Blahs:
For years, there has been a controversy regarding the association between depression and beta blockers like atenolol (Tenormin), metoprolol (Toprol) and propranolol (Inderal). Perhaps the doctors our reader saw doubted the connection.
A new study published in the journal Hypertension (October 10, 2016) demonstrates that there is indeed a link between beta-blocker treatment and hospitalization for serious mood disorders (major depression and bipolar disorder). The investigators reviewed the records of 114,066 patients taking antihypertensive medication for at least 90 days. Out of this group, 299 people were hospitalized for a mood disorder. Those who were taking beta blockers or calcium channel blockers such as amlodipine (Norvasc) or nifedipine (Procardia) were twice as likely as people taking ACE inhibitors (ACEis) or ARB drugs to require hospitalization for depression.
In fact, those being treated with ACEis like lisinopril and ramipril or ARB medicines like losartan and valsartan were less likely to become depressed than patients who were not taking any blood pressure pills.
Other Drugs Linked to depression:
Hormonal Birth Control:
Many other medications can also trigger depression. A study in JAMA Psychiatry (online, Sept. 28, 2016) noted that young women on hormonal contraceptives such as birth control pills or patches are significantly more likely to need treatment for depression. The link was especially worrisome among adolescents.
The Stop Smoking Drug Chantix (Varenicline):
A black box warning (the very strongest alert) comes with the Chantix prescription information. It states:
“Serious neuropsychiatric events including, but not limited to, depression, suicidal ideation, suicide attempt, and completed suicide have been reported in patients taking CHANTIX…
“All patients being treated with CHANTIX should be observed for neuropsychiatric symptoms including changes in behavior, hostility, agitation, depressed mood, and suicide-related events, including ideation, behavior, and attempted suicide. These symptoms, as well as worsening of pre-existing psychiatric illness and completed suicide, have been reported in some patients attempting to quit smoking while taking CHANTIX in the postmarketing experience. When symptoms were reported, most were during CHANTIX treatment, but some were following discontinuation of CHANTIX therapy.”
Such warnings rarely reveal what it’s like to actually experience an episode of depression associated with such a medication. Here are just a handful of stories we have received from patients.
This poignant message comes from B.S.
“I have never had an issue with depression. I have cried once in the past 25 years and consider myself a very strong minded individual. Others will attest to that.
“After two weeks of taking Chantix that all changed. I became depressed, wanted to leave a marriage that was like a fairy tale. That’s because it is that good after twenty years. She is the woman that made me the success that I am today.
“I started crying, started to become very unhappy and lost all emotions to people around me. I still feel it and did tell my wife I was unhappy and I’m losing interest; she replied that we will fight this and the drug. She never got upset, just wanted to help. I still feel down and will fight this the best way I can which I am not sure of how to do.
“This drug brought back old memories and feelings from the past. I am trying really hard to fight this but feel I am losing the battle. I feel ashamed, bad for the people that care for me as much as they do and I cannot return that favor anymore. I will do the noble thing and stay with what I have and be content with it.
“I never thought I could stop loving but this drug had done this to me. It was like overnight. I never knew what hit me. Before taking the drug I was very happy, no regrets of anything, loved and respected everyone around me. I am 100% positive this drug caused the change.”
“I just found this site after wondering why I’ve been so depressed lately. I quit smoking two months ago, work out almost every day, have a great job and a great kid. By all accounts I should be stoked on life.
“Instead I’ve been so depressed that I’ve been skipping work, skipping social events, and just staying home for weeks. The drug is amazing in that it made me quit cold turkey after smoking for 25 years with zero urge to relapse, but this malaise is unbearable.”
“Former Flyer” suggests keeping a mental diary:
“I used Chantix several years ago before they started warning about depression. It has been over four years, and I still haven’t recovered completely. I have to be constantly on guard with my mental state. I had never been suicidal. I had no prior history of depression, but now I go into an ‘I don’t give a *!&* about anything’ state.
“While I was taking this med, I was really really bad. This is after 50 years as a classic Type A personality. The drug ruined me financially. That is pretty catastrophic when you are self employed and start have that attitude.
“Now, if I am prescribed another drug by my doc, I keep a detailed mental diary of my mental state because it seems that many medications will trigger depression. The statins for cholesterol seem particularly troublesome (even though I compensate with CoQ10). The only cholesterol med tolerable to me seems to be Lipitor. But the copay is through the roof. Even a so called ‘generic Lipitor’ screws me up. But Chantix was the worst.”
Who would ever associate antibiotics with psychological side effects like depression? Most people think of such drugs as magic bullets against infection. And yet quinolone-type antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox) or norfloxacin (Noroxin) have been linked with side effects such as agitation, anxiety, irritability, confusion, depression, and suicidal thoughts.
“Fluoroquinolone [FQ] toxicity is far less rare than people assume. Delayed reactions and tolerance thresholds are’t taken into consideration when determining how many people react badly to these antibiotics. Also, doctors fail to acknowledge that multi-symptom, often chronic, diseases were caused by fluoroquinolone antibiotics.
“Adverse effects of FQs include many psychiatric issues like anxiety, depression and even bipolar disorder. Who would connect anxiety attacks to an antibiotic taken weeks ago? But they are connected.”
What Can Patients Do?
Antidepressants may not overcome mood disorders that are triggered by medication. That’s why doctors need to warn patients about the potential psychological side effects of their prescriptions in advance. If people are not alerted to this possibility, they may not realize that their low mood might be linked to their medicine. Anyone who starts to feel depressed should always ask both the prescriber and the pharmacist whether a medication could be contributing to the mood disorder.
To better understand how to recognize depression and learn about a variety of treatment options, you may wish to read our Guide to Dealing with Depression. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (68 cents), self-addressed envelope:
- Graedons’ People’s Pharmacy, No. E-7,
- P. O. Box 52027,
- Durham, NC 27717-2027.
It can also be downloaded for $2 from the website: www.peoplespharmacy.com.