The People's Perspective on Medicine

Is Your Blood Pressure Medicine Making You Sad and Depressed?

When someone feels depressed it's common to wonder what triggered the negative feelings. A loss is a common cause, but many drugs can also cause depression.

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.

Drug-Induced Depression:

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.

Patient Stories:

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.”

N.A. says:

“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.”

Fluoroquinolone Antibiotics:

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. 

Lisa says:

“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.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Dealing with Depression
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My BP became unstable after a stressful life event. I tried HCTZ, Lisinopril and Amlodipine, all with side effects that I couldn’t tolerate. That led me to Losartan Potassium and HCTZ (100 mg/12.5 mg). At last my BP was stabilized. However the side effects were very subtle, yet debilitating to my quality of life. As time progressed, I have had severe fatigue, loss of interest in activities and feelings of isolation that were caused by medicine. It is obvious that I need to get the dosage decreased in half. My BP is 97/59 with heart rate of 63, so my prescription needs to be adjusted. My goal is to come off the BP meds altogether, as I continue to lose weight with DASH Diet and exercise.

I have the same problems with blood pressure and antidepressant med. Have even had my heart dr. not doctor me any more because I kept complaining. Drs. think they know every thing, but they don’t. What are we to do? We can’t take risks, can’t tolerate their meds. What is left?

I have been on Propranolol extended realese couple of years ago It was prescribed for my POTs to slow my Heart Rate down. The medication worked but After a week or so I started to sleep more, wanted to be alone ,didn’t want to eat or cook and etc… I work from home and my job challenging and exciting Well, after few weeks I didn’t care if there were orders to process, didn’t want to communicate with customers.

I had to force myself to do things that I normally couldn’t wait to wake up and to start my day. After 6 months I was really depressed I had suspicions and spoke to My Cardiologists nurse but she said that Depression is highly unlikely. It was safe for me to 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 disappear I felt happy.

Well, went to my Cardiologist ,told him what happened and he said that one of very common side effects of beta blockers is Depression. Come on,really??? Was it hard to mention before he put me on it. Doctors these days care about how little time they can spend with you and how big they can charge you.

I have been taking propananolo, to control high blood pressure and/or cholesterol. I can’t remember if my doctor told me of the side effects. I was having bouts of anxiety. I’m sorry this is not to the point. My statement is that these meds are dangerous. Doctors do not listen and are being used by the pharmaceutical companies. I want to know if you can get off of these drugs without bringing on a heart attack or a stroke.

Forgot to mention. I am on 3 different blood pressure meds. Couldn’t understand why my life and health had PLUMMETED so drastically…well, after researching online, the BP meds these morons have me on, I was shocked, and angered beyond belief to see that on all 3 meds, “”lisinopril, carvedilol, amlodepene” … out of the tons of SIDE EFFECTS listed on major med sites, at least 3/4 of the side effects related to the nightmare I have been experiencing. Even suicidal thoughts. Lovely, what a country!! I’m getting the heck out of Florida ASAP!!!

i am convinced that the medications I take have caused my lack of energy, malaise, eating, and insomnia. When I wanted to stop taking them , after a prescription review I was told the benefits outweighed the side effects. I am not convinced. There is only one of the medications which still has serious side effects that I might need because it controls the neuropathy and nerve pain.

I had to take a beta-blocker for about a year due to a cardiac condition now resolved. The side effects were: FEELING FUZZY-HEADED AND WEAK! Especially weak! I’m a backpacker and skier, and I INSTANTLY noticed that the things I could easily do before the beta blocker now exhausted me. There were some steep hikes that I simply couldn’t do! As soon as that beta blocker was discontinued, my sports abilities went right back to where they had been before, thank heavens.

My deceased husband was on tenormin (and Mevacor) many years ago. He became an extremely cranky, irritable and argumentative person and it was obvious to both my son and myself that it came from the medication. However, doctors then and doctors now hate to admit to side effects. They think they are scientists practicing evidence based medicine; however, it has become no secret that drug companies hide side effects when reporting on clinical trials, thus, their evidence is flawed.

Oddly enough, Cymbalta and Effexor taken for back pain both have caused me to be depressed, lose motivation and compulsively play solitaire online all day to the exclusion to all other activity.

My deceased husband, who was funny, athletic and ambitious, started to “change” when they put him on high blood pressure meds, and Lipitor.

All of those meds caused other side effects, which the doctors “helped” by giving more meds to counter the side effects of the prior meds.

Meanwhile, I saw what the cause was, but my husband, not the same man, now did not listen to me, nor did he laugh, nor did he eat healthy like he always had. It seemed he craved carbs more.

In any event, after the doc changed his blood pressure meds, once again, he took one in the morning and a different one in the evening. He still swam 40 laps 4 times a week in an olympic pool at the Y, but he was not enjoying life.

His pulse started to go way down – to 39!! He called his doctors, but they told him it “was normal” and one day, he called very afraid. The nurse told my husband the doctor (his cardiologist) was “in surgery” and would call him back.

He never called back, so my husband did not take the nightly med, and he did feel his pulse was back to “normal” the next day. He decided to go swim his 40 laps. First, though, he said he would take the blood pressure med he did not take the night before. A few minutes later, when he didn’t appear, I walked into the bedroom and found him dead. He died standing up and folded down to his knees and his head on the ground. No CPR or medic could bring him back. A few minutes after he died, his cell phone rang, and it was the nurse from the cardiologist’s office asking for my husband. When I told her he was dead, she gasped. I asked why the doctor didn’t call back the day before, and she started to cry and said the doctor was out of town with his new girlfriend and asked her to tell his patients he was in surgery.

So there it is. BTW: Ten days later, the cardiologist abruptly shut down his practice (leaving thousands of patients without help) and moved to another state and became an important cardiologist at a big Airforce Base there.

Happy ending for him. Heartbreaking and tragic ending for my family and maybe some more tragic endings for his future patients of that cardiologist who just pushes pills on to people who trust him.

I have no doubt that depression and many other undesirable side effects can occur with most drugs. I would like to point out, however, that the act of quitting smoking itself can cause depression. I quit smoking after 35 years and I felt like I lost my best friend.

That feeling lasted for some time but eventually eased then completely resolved. My question is why is Chantix still prescribed? Black box warning? That is ineffective because you don’t even get the box until you get your script filled & then you can’t return it to the pharmacy. I thought the FDA is supposed to protect us from harmful drugs.

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