Monday, June 25, 2018

Which prescription medications are linked to depression?

- Jennifer Middleton, MD, MPH

Perhaps your patients have asked you if the medications they're taking are linked to an increased risk of depression as this study, "Prevalence of Prescription Medications with Depression as a Possible Adverse Effect Among Adults in the United States (US)," has been widely disseminated in the lay press over the last week.

The authors examined data from 2005-2014 from the National Health and Nutrition Examination Survey (NHANES), which included over 26,000 US adults. The NHANES data includes all medications that participants reported during these times, and the study authors identified medications that have depression as a listed potential side effect, which they termed "depression adverse effect medications." Overall, during this 10-year time period, 21% of surveyed adults took at least 1 of these medications, 8.7% took 2, and 7.5% took 3 or more. The prevalence of depression increased proportionally to the number of depression adverse effect medications adults were taking; adults taking none had a 4.7% prevalence of depression, adults taking 1 had a 6.9% prevalence of depression, adults taking 2 had a 9.5% prevalence of depression, and adults taking 3 or more had a 15.3% prevalence of depression. The most commonly prescribed depression adverse effect medications were metoprolol, atenolol, omeprazole, hydrocodone, gabapentin, and oral contraceptives. Use of multiple non-depression adverse effect medications was not associated with an increased prevalence of depression.

Observational studies can only prove correlation, not causation; the authors appropriately limited their conclusions to noting linkages between depression diagnoses and the use of depression adverse effect medications. The premise that we should consider how the medications we prescribe might contribute to mood diagnoses, however, is a reasonable one. The authors note that current screening instruments do not include review for possible depression adverse effect medications; it may be worth considering adding an assessment of current medications to whichever tool your practice uses.

The United States Preventive Services Task Force (USPSTF) recommends screening all adults for depression, and there is still plenty of room to improve mental health screening rates in the US. There's an AFP By Topic on Depression and Bipolar Disorder that includes this article on "Screening for Depression" that describes currently available instruments.

Will these results from the NHANES change how you prescribe medications that may contribute to depression?

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