This week, a new study highlighted the fact that there are many prescription drugs on the market that have been linked to depression—and many people may be taking at least one of them. The study, which was published in JAMA, found that more than one-third of Americans are taking at least one prescription drug that lists depression as a potential side effect. On top of that, people who take those drugs have higher rates of depression than those who don’t.
For the study, researchers from the University of Illinois at Chicago and Columbia University analyzed U.S. population-based survey data from the National Health and Nutrition Examination Survey that was collected between 2005 and 2006 and collected again between 2013 and 2014. Overall, data from 26,192 adults were part of the study, and experts found that 37.2 percent of them used medications with depression listed as a potential side effect (including painkillers, hormonal birth control, and psychiatric medications among many others). Additionally, the number of people using these medications increased during the years studied from 35 percent between 2005 and 2006 to 38.4 percent in 2013 and 2014.
Of the people studied, 7.6 percent reported having depression. And 6.9 percent of people reported using three or more medications with depression as a potential side effect—and those people were also more likely to report having depression than those taking fewer medications. Specifically, 15 percent of people who took three or more medications with depression listed as a potential side effect reported having depression compared to 4.7 percent of people who didn’t use those medications.
“It's a reminder that while many prescription medications have therapeutic benefits, they also carry risks, including depression,” lead study author Dima Mazen Qato, Ph.D., Pharm.D., an assistant professor and pharmacist at the University of Illinois at Chicago, tells SELF.
However, it’s not totally clear how certain medications impact your risk for depression, if at all.
The study found that about 200 prescription drugs list depression as a potential side effect, including medications like hormonal birth control pills, emergency contraceptives, prescription-strength ibuprofen, proton pump inhibitors (which are used to treat acid reflux), beta-blockers (which treat high blood pressure), and corticosteroids like prednisone (which is used to treat a range of conditions, including arthritis, severe allergies, and skin diseases).
Clearly, this encompasses a pretty wide range of health issues and drugs that people might take to help those conditions, so it's not all that surprising that so many people are taking drugs that list depression as a possible side effect.
But these drugs don't all share some common mechanism that might increase your risk for developing depression, Jamie Alan, Ph.D., Pharm.D., an assistant professor of pharmacology and toxicology at Michigan State University, tells SELF. So if they actually do increase the risk, the way they do so “really varies per medication,” she explains. “Some, like drugs for hepatitis, are directly related [to depression], while for other drugs the mechanism isn’t entirely known.” There could even be a separate factor that's associated with a greater likelihood of depression and a greater likelihood of taking that medication that's actually to blame.
Depression is a complicated disorder, and it can be difficult to attribute it to any one thing, like a medication.
Study co-author Mark Olfson, M.D., M.P.H., a professor of psychiatry and epidemiology at Columbia University Medical Center, tells SELF that it’s important to keep all of this in perspective. “A great majority of people who were taking these medications, even those who were taking three or more of them, were not depressed,” he notes.
“Depression is a serious medical condition that can develop based on any number of factors,” Samar McCutcheon, M.D., a clinical assistant professor of psychiatry at The Ohio State University Wexner Medical Center, tells SELF. Factors like going through a traumatic event, having a family history of depression, or having a serious or chronic illness may increase your risk for depression alongside taking certain medications, the Mayo Clinic says.
Based on the study’s findings and the fact that depression is so complex, “it’s not possible to say with certainty” that these medications were the only reason why some people developed depression, Dr. McCutcheon says. Even Qato says that her work doesn’t show a cause and effect relationship: “This study doesn't prove that taking medications with depression as a side effect causes depression,” she explains. “It demonstrates that there is an association between the number of medications used with depression or suicidal symptoms as an adverse effect and depressive symptoms.”
The way a side effect gets listed on a medication is a little convoluted.
A drug has to undergo several clinical trials before the Food and Drug Administration (FDA) approves it, as the FDA website explains. During those trials, drug makers will look for any side effects that people experience and report those to the FDA, Dr. Alan says.
According to regulations, a company must display the most frequent side effects of a prescription medication in its labelling in decreasing order of frequency, FDA spokesperson Lyndsay Meyer tells SELF. Additionally, any adverse reactions included in the labeling are limited to those "for which there is some basis to believe there is a causal relationship between occurrence of an adverse event and the use of a drug," Meyer says.
But, “the tendency for companies is to make a really inclusive side effect list for legal reasons,” Dr. Alan says. So, a drug company may add depression as a potential side effect to the label even if only a small percentage of people who used the drug developed depression while they were taking the drug, which may or may not have been related to the medication itself, just so there aren't any surprises.
Once a drug goes on the market, it will continue to be monitored via post-market surveillance, and people who take the drug can report any side effects directly to the FDA. Still, “it’s hard to wade through what’s concerning and what’s not concerning,” Dr. Alan says.
What doctors do know is that, if you're taking multiple drugs with similar side effects, your chances of developing that side effect increase, as this recent study found.
If you’re taking a medication that lists depression as a potential side effect, it’s important to at least be aware of that—especially if you already have other risk factors for depression.
To find out if your drug is linked to an increased risk of depression, take a look at the pamphlet that came with it. Or, if you tossed that a while ago, look up the drug’s website—many list potential side effects on the homepage.
If you’re taking one of the drugs included in this study, it’s also good to have an understanding of the symptoms of depression, Igor Galynker, M.D., associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel, tells SELF. That includes a persistent feeling of sadness, feelings of hopeless, guilt, worthlessness, and helplessness, a loss of interest in doing things, fatigue, difficulty concentrating, insomnia, low appetite, restlessness or irritability, unexplained aches and pains, and thoughts of death or suicide, according to the National Institute of Mental Health.
However, as Dr. Galynker points out, it can be difficult to notice a pattern of changes in your mood. Plus, it can take weeks for mood changes to actually happen after you start taking a medication, he says, making it even more challenging to connect the dots.
If you notice that you’re having signs of depression and you recently started taking a new medication, talk to your doctor, Dr. Olfson recommends. They'll help determine whether or not your medication may be impacting your mood and can recommend an alternative. If you have a history of depression, definitely ask your doctor about potential side effects of new medication when it’s prescribed so it’s at least on your radar, Dr. Galynker says.
And again, don’t hesitate to ask for help if you need it. “This doesn’t make you weak,” Dr. Alan says. “Let us help you.”