Could Your Depression Be Related to Your Medication?
After two weeks of taking isotretinoin, an acne medicine, 19-year-old Joe began experiencing fatigue, lack of motivation, sleep problems, and crying spells. He was diagnosed with depression (something his doctor eventually believed was related to his use of isotretinoin). When Joe stopped taking the medicine, his symptoms quickly resolved.
In 2005, the Food and Drug Administration (FDA) issued a warning about isotretinoin, stating that it can cause symptoms of depression or suicidal thoughts. But numerous other medicines can also cause depression.
Symptoms of Depression
Depression is a condition characterized by feelings of profound sadness and a lack of interest in formerly enjoyable activities. Symptoms may include:
- Persistent feelings of sadness, anxiety, or emptiness
- Hopelessness
- Feeling guilty, worthless, or helpless
- Loss of interest in hobbies and activities
- Loss of interest in sex
- Feeling tired
- Trouble concentrating, remembering, making decisions
- Trouble sleeping, waking up too early, or oversleeping
- Eating more or less than usual
- Weight gain or weight loss
- Thoughts of death or suicide, with or without suicide attempts
- Restlessness or irritability
- Physical symptoms that defy standard diagnosis and do not respond well to medical treatment
Medications Reported to Cause Depression
This table, from the The Medical Letter on Drugs and Therapeutics, provides examples of medicines that can cause depression:
| Drug | General Treatment Uses |
|---|---|
| Acyclovir (Zovirax) | Chickenpox, shingles, herpes |
| Amphetamines | Attention deficit hyperactivity disorder, narcolepsy |
| Anabolic steroids | Often used illicitly by athletes to build muscle |
| Anticonvulsants | Seizures, epilepsy, pain |
| Asparaginase (Elspar) | Blood cancers |
| Baclofen (Lioresal) | Muscle spasms, cramps, muscle tightness from multiple sclerosis, cerebral palsy, and spinal cord injuries |
| Barbiturates | Seizures, insomnia |
| Benzodiazepines | Anxiety, convulsions, insomnia |
| Beta-adrenergic blockers (beta blockers) | Cardiovascular conditions |
| Bromocriptine (Parlodel) | Menstrual problems, lactation problems, infertility, Parkinson’s disease, acromegaly, tumors of the pituitary gland |
| Calcium channel blockers | Cardiovascular conditions |
| Corticosteroids | Inflammatory conditions, asthma, arthritis, cancer |
| Cycloserine (Seromycin) | Tuberculosis |
| Dapsone (Aczone) | Leprosy, dermatitis herpetiformis |
| Digitalis (Lanoxin, digoxin, digitoxin) | Cardiac conditions |
| Disopyramide (Norpace) | Abnormal heart rhythms |
| Disulfiram (Antabuse) | Alcohol abuse |
| Estrogens | Menopause, prevention of osteoporosis, certain cancers |
| Fluoroquinolone antibiotics | Bacterial infections in different parts of the body |
| Histamine H2-receptor antagonists | Acid-related diseases of the gastrointestinal tract |
| HMG-CoA reductase inhibitors (statins) | Lipid disorders |
| Interferon alfa (Roferon-A) | Hairy cell leukemia, malignant melanoma, AIDS-related Kaposi’s sarcoma, growths in the respiratory tract, genital warts, certain types of hepatitis |
| Isotretinoin (Accutane) | Severe acne, rosacea, other skin diseases |
| Levodopa (Dopar) | Parkinson’s disease |
| Mefloquine (Lariam) | Malaria prevention and treatment |
| Methyldopa (Aldomet) | High blood pressure |
| Metoclopramide (Reglan) | Diabetic gastroparesis, nausea, vomiting, fullness after meals, loss of appetite, heartburn |
| Metrizamide (Amipaque) | For diagnosis of brain disorders, cardiac disease, central nervous system disorders, urinary tract disorders, vascular disease |
| Metronidazole (Flagyl) | Infections |
| Narcotics | Pain |
| Nonsteroidal anti-inflammatory drugs | Arthritis, inflammatory conditions, pain |
| Pergolide (Permax) | Parkinson’s disease |
| Progestins, implanted (Norplant) | Birth control |
| Sulfonamides | Infections |
| Thiazide diuretics | High blood pressure |
| Vinblastine (Velban) | Certain cancers |
Other medicines may also cause depression. Talk to your doctor and pharmacist about your concerns.
Medication or Depression: Which Comes First?
Do certain medicines cause depression, or are people with depression more apt to take certain medicines? The relationship is not always clear.
According to the National Institute of Mental Health, people taking medicines that are linked to depression often have chronic conditions, such as cancer or cardiovascular disease, or an unrecognized mental illness, which may also put them at risk for depression. Furthermore, they may also be dealing with psychosocial factors, such as disability, unemployment, and other stressors that increase their risk for depression.
It is also known that people with a personal history of depression are more likely to experience depression as an adverse reaction to certain medicines. Nonetheless, drug-induced depression does not generally meet diagnostic criteria for “major depressive disorder.” Instead, it more commonly resembles “atypical depression,” suggesting that drugs may indeed be the cause in affected individuals.
The elderly may be at higher risk for drug-induced depression. Many elderly people take multiple medicines, and it is possible that drugs which may not cause depression when given by themselves could do so when given in combination. While many drugs (as in the above list) have been thought to be able to cause depression, rigorous studies provide at least limited evidence for causation in only a few. Among these better-proven causes are:
- Mefloquine
- Alpha interferon
- Interleukin-2
- Gonadotropin-releasing hormone agonists
- Progestin-releasing implanted contraceptives
- Corticosteroids
- Propranolol
Of these drugs, only the last three are commonly prescribed. The others are typically used to treat serious or life-threatening conditions in people under close medical supervision.
Talk to Your Doctor
Most people who take any of the medicines above will not become depressed. And not all cases of depression in people taking these medicines will be a result of the medicine. However, if you are taking one or more of these medicines and have been feeling unusually sad, talk to your doctor about it. But even if you are not taking a medicine on the list, talk to your doctor about any symptoms of depression you may have. Whatever the cause, treatment can make you feel better, be more productive, and be better able to overcome whatever other health problems you might have.
REFERENCES:
Beers MH, Passman LJ. Antihypertensive medications and depression. Drugs. 1990;40(6):792-799.
Bender, K. New warning of depression with Accutane could apply to other medications. Psychiatric Times . 1998;15:1-7.
Kotlyar M, Dysken M, AdsonDE. Update on drug-induced depression in the elderly. Am J Geriatr Pharmacother. 2005;3:288-300.
Some drugs that cause psychiatric symptoms. Medical Letter. 1998;40:21-24.
United States Pharmacopeial Convention. USP DI. 21st ed.Greenwood Village,CO: Micromedex; 2001.
