7 Common Medications that Could Be Making You Depressed

While medications are supposed to make you feel better, which most of the time they do, they also come with side effects. While unwanted, they are usually minor, though in some cases, they can be serious. Some drugs may cause depression, regardless of whether or not you're predisposed to mental health problems. 

 

According to a study published in JAMA, more than one-third of adults may be using prescription medications which have the potential to cause depression and may also increase the risk of suicide. As part of the study, researchers found that more than 200 commonly used drugs have depression or suicide listed as potential side effects. 

 

However, because many of these drugs - including hormonal contraceptives, blood pressure and heart medications, antacids, and painkillers - are prescribed for purposes unrelated to mental health, it's worrying that patients may never be warned about the increased risks. Below are some commonly used drugs that are sometimes linked to depression. Be sure to talk to your doctor if you're taking any one of these.

1. Beta blockers  

 

Beta blockers such as metoprolol are widely prescribed to treat high blood pressure. They are also used for chest pain, irregular heartbeat, migraine, some tremors, and even glaucoma. It is especially used for hypertension, beta blockers are used long-term, however, research has also linked it with depression. Thankfully, there are plenty of alternatives and beta blockers aren't used as often anymore. Joshua Nathan, MD, president-elect o the Illinois Psychiatric Society and assistant professor of clinical psychiatry at the University of Illinois Chicago says "they've gone a little out of favor as a standard treatment because there are newer things that may work better without (the risk of depression)." 

 

2. Corticosteroids 

Steroids like prednisone are used to treat a surprising number of conditions, including autoimmune diseases like rheumatoid arthritis and lupus, asthma, allergies, and cancer. However, they can have an effect on mental health. "Chronic use is associated with a range of psychiatric problems. It can cause depression, anxiety, psychosis - and I've seen all of those things," Dr. Nathan says. Euphoria and mania seem to be more common with short-term use while depression becomes more prominent with longer use, even if the doses aren't large. Furthermore, a family history of depression or alcoholism could put you at a greater risk for developing one of these side effects when using corticosteroids. Talk to your doctor or specialist about your risk factors and medication alternatives. 

 

3. Antibiotics  

While this does not apply to all antibiotics there are some which have been linked with depression, notably levofloxacin and ciprofloxacin. Both belong to the family of antibiotics known as fluoroquinolones and are prescribed for a variety of bacterial infections. A large study conducted in the United Kingdom found that just one course of quinolones was linked with a 25% higher risk of depression. Furthermore, taking one course of med in the penicillin group of antibiotics was associated with a 23% higher risk of depression. Two courses of penicillin took the risk up to 40%, and more than five courses involved a 56% higher risk. With this in mind, it is essential that you take antibiotics only when you need to. Overusing can also contribute to the spread of antibiotic-resistant bacteria. 

 

4. Interferon 

It has been found that 40% of people being treated with interferon develop depression. The drug is used to treat some cancers and viral infections like hepatitis C, among other things. Once the treatment has ended, depression usually goes away. However, one study found that it could come back later. Because interferon combats life-threatening illnesses, antidepressants are sometimes used so that a person can continue the treatment. Research has shown that selective serotonin reuptake inhibitors (SSRIs) and other classes of antidepressants can bring relief up to 85% of people who develop depression during interferon treatment. medications that cause depression

5. Anticonvulsants  

According to some reports, anticonvulsant (or anti-seizure) drugs like topiramate and gabapentin may contribute to depression. These drugs suppress the central nervous system and may be associated with depression. Benzodiazepines, such as anti-anxiety meds Xanax and Valium, are also CNS depressants and have been associated with depression. Thankfully, medication-induced depression goes away when you stop the medication. Anticonvulsants are now used to treat bipolar disorder too, pain from damaged nerves and fibromyalgia. There are other treatments for all of these conditions, and there are also alternatives for benzodiazepines. 

 

6. Opioids 

The addictive painkillers - which are responsible for one of the greatest public health crises in American history-also seem to increase the risk of depression. In one study, it was found that the risk of depression in people who had never had it increased the longer they took opioids, starting at about 30 days. The dose didn't seem to play a role. People with these mood disorders are at a greater risk of abusing opioids. 

 

7. Hormonal birth control 

Some studies have found a correlation between contraceptive methods (including birth control pills, patches, vaginal rings, and hormonal IUDs) and depression or lower quality of life. Researchers say that hormonal changes triggered by these medications, such as a decrease in testosterone or an increase in progesterone, may play a role. Nevertheless, it is important to take these findings with a grain of salt and to also bear in mind that birth control can affect each woman differently. A recent review published in Contraception found that there is no link between hormonal contraception and depression. Furthermore, a study published last year in Menopause discovered that hormonal birth control may actually protect women from depression later in life.

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No role of Opioids in reducing pain and disability in chronic osteoarthritis

Opioids provided no clinically relevant pain relief and no clinically relevant reduction in disability compared with placebo in chronic osteoarthritis pain (hip, knee), according to a recent study published in the European Journal of Pain. 

Osteoarthritis (OA) is the most common form of arthritis which has become one of the leading causes of disability in older adults. It occurs due to the break down of cartilage, causing the bones within the joints to rub together causing pain, stiffness, and other symptoms.

OA occurs most often in older people, although it can occur in adults of any age. OA is also called degenerative joint disease, degenerative arthritis, and wear-and-tear arthritis. 

The major treatment hurdle for osteoarthritis is the absence of any good disease-modifying drugs for this disease. Without effective treatment, physicians are left to manage patients symptomatically and the most common thing done by them is to manage their pain. One of the main culprits [driving opioid use] are chronic pain patients and one of the most highly prescribed conditions for opioids is osteoarthritis.

This updated systematic review by Winfried Häuser, Health Care Center for Pain Medicine and Mental Health, Saarbrücken, Germany, and colleagues, evaluated the efficacy and safety of opioids compared with placebo for chronic osteoarthritis pain. 

For the purpose, the researchers searched the online databases from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double‐blinded duration were analyzed. A total of 22 studies with 8,942 participants were included in the meta-analysis. Study duration ranged between 4 and 24 weeks.

Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Key findings of the study include: 

Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with the placebo. 

There was clinically relevant harm related to the dropout rate due to adverse events. 

The frequency of serious adverse events did not differ from placebo. Enriched enrolment randomized withdrawal design: 

Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo.
 Dropout rates due to adverse events and frequency of serious adverse events did not differ from placebo. 

"Tolerability of opioids is low and efficacy is not clinically relevant in controlled studies from 4 to 24 weeks for osteoarthritis pain," wrote the authors. 

The study, "Opioids for chronic osteoarthritis pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks double‐blind duration," is published in the European Journal of Pain.

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Study suggests chronic opioid treatment may increase PTSD risk

Researchers have found that long-term (chronic) treatment with opioids, such as morphine, prior to trauma may increase post-traumatic stress disorder (PTSD) risk.

The findings, published in the journal Neuropsychopharmacology, which link chronic opioid treatment before a traumatic event with responses to subsequent stressful events, may suggest a possible mechanism underlying the frequent co-occurrence of post-traumatic stress disorder (PTSD) and opioid dependence.

"Our data are the first to show a possible effect of opioids on future fear learning, which may suggest that a person with a history of opioid use may become more susceptible to the negative effects of stress," said a researcher.

"Also, this ability of opioids to increase PTSD-like symptoms far outlasted the direct effects of the drug or withdrawal from the drug, suggesting that the effect may continue even after opioid treatment has stopped," he added. Previous research has shown that PTSD increases the risk of opioid dependence, but whether opioid dependence may also increase PTSD risk remained unclear.

Using an established model of fear learning in mice, researchers assessed the potential impact of chronic opioid treatment on subsequent development of PTSD-like behaviours. They found that mice that had been treated with opioids and later experienced stress showed more pronounced post-stress reactions.

At the beginning of the study, mice were treated with morphine or saline for eight days, followed by a week of drug cessation. Both groups of mice - morphine-treated mice and saline-treated controls (22 and 24 mice, respectively) - were then subdivided into trauma and non-trauma groups.

They were transferred to a chamber where animals in the trauma group received a series of mild foot shocks. A day later, both groups of animals were returned to the chamber to assess their memory of the traumatic event.

"We have called this the trauma because the acute stressors, the foot shocks, is able to produce lasting fear and anxiety-like behaviours, such as freezing," the researcher said.

On the subsequent day, mice from both the trauma and non-trauma groups were transferred to a new environment and exposed to a mild stressors (a milder foot shock), before being returned to that environment for eight minutes on the fourth day of the experiment.

The authors found no behavioural differences between morphine-treated and control mice following the initial trauma. However, morphine-treated mice showed more pronounced freezing when returned to the second environment after having been exposed to the mild stress.

The findings suggest that chronic exposure to opioids before - but not after - a traumatic event occurs, impacts fear learning during subsequent stressful events.

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Opioids do not improve quality of life or depression in OA patients

New research presented at the 2019 ACR/ARP Annual Meeting suggests that opioids contribute no measurable benefit to quality of life or depression for patients with osteoarthritis (OA).

Researchers also found only small benefits on pain and function after two to 12 weeks of treatment, and interestingly, strong opioids had consistently worse pain relief benefits and a greater risk of any safety-related outcome than weak opioids in this meta-analysis.

Osteoarthritis is a common joint disease that most often affects middle-age to elderly people. OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments and bone. OA is characterized by breakdown of cartilage tissue, bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the joint lining (called the synovium).

Opioids, long prescribed for chronic pain, have many safety concerns. The lack of information about opioids' efficacy for OA pain relief, and no clear delineation between overall efficacy and safety between strong and weak opioids, prompted the study.

Given the current controversy regarding the use of opioids in chronic pain, we wanted to delve deeper into the efficacy and safety profiles of oral opioid drugs in osteoarthritis patients. Temporal assessments can reveal peak periods of efficacy and can provide clinicians with a blueprint for optimal durations of treatment regimens.
Our study also provides an important update to the evidence body by evaluating patient reported outcomes of quality of life, depression and sleep that are relevant to clinicians and patients alike,"

Raveendhara R. Bannuru MD, PhD, FAGE

Bannuru is the director of the Center for Treatment Comparison and Integrative Analysis at Tufts Medical Center in Boston and the study's lead author.

The study included meta-analyses of pain and function at two, four, eight, and 12 weeks. It also analyzed relevant safety outcomes for all opioids, as well as strong versus weak opioids.

They searched various Database from inception to April 2019, and actively sought unpublished data. They included placebo-controlled, randomized controlled trials assessing the efficacy and/or safety of FDA-approved opioids in patients with knee and/or hip OA.

Of the 23 randomized controlled trials included, there were 11,402 participants and 64 percent were female. The participants' mean age ranged from 54 to 67 years.

Their mean body-mass index (BMI) ranged from 28 to 34 kg/m². All of the trials included in the study were of moderate quality, and potential attrition bias was the primary methodological concern.
Overall, the results showed that opioids demonstrated small, statistically significant benefits on pain at each time point.

Similarly, the researchers observed small, statistically significant effects on function at two, four, eight, and 12 weeks. Opioids had no impact on quality of life or depression.

Strong opioids consistently had smaller benefits on pain than weak opioids, the study found. Though results of meta-regression exploring dose effects revealed a relevant relationship between opioid dosage, or morphine equivalency, and the magnitude of pain relief, participants receiving strong opioids were nearly twice as likely to discontinue due to adverse events than those receiving weak/intermediate opioids.

One possible reason is that many participants who received strong opioids were unable to achieve the optimal therapeutic dose as a result of attrition related to a lack of tolerability.

Strong opioids overall showed a consistently worse safety profile than weak opioids, particularly drug withdrawal symptoms and discontinuations due to adverse events.

"Strong opioids' under-performance was the study's most interesting finding, and likely due to the relationship between pain relief and tolerability of opioids based on dose," says Dr. Bannuru.

"We observed a relevant relationship between morphine dose equivalency and the magnitude of pain relief at the final follow-up. However, the relative risk of discontinuation due to adverse events among participants receiving strong opioids was nearly twice that of participants receiving weak opioids. These results suggest that many people who receive strong opioids may be unable to achieve the optimal therapeutic dose due to a lack of tolerability."

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Anti-depressants raise hip fracture risk in elderly

Elderly people who take anti-depressants or opioids are more than twice as likely to suffer a fractured hip after a fall, a new study has found.

The study revealed that the risk of fracturing a hip was significantly higher among those who were taking multiple psychotropic medicines mood and conscious-altering medications that aare used to treat conditions ranging from depression to dementia, it was reported.

Anti-depressants, opioids, anti-epileptic medicines, benzodiazepines (which are used to treat anxiety) and anti-psychotics ( which are used to treat schizophrenia and bipolar disorder) all increase the risk of hip fractures, lead author said.

Combining them increases the risk even further, up to 5 times in the case of starting anti-depressants and anxiety medicines together.

This equates to one extra hip fracture for every 17 patients aged 80 years older who are treated for a year.

This risk of falling can be lowered by reducing medicine use, exercising more and using other interventions such as occupational therapy and podiatry, the researchers said.

Australians are among the highest users of anti-depressants in the world, with approximately 10% of the adult population taking them every day.

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Opioids may increase risk of falls, death in elderly says research

Older adults who use opioids for pain relief may be at an increased risk of falling as well as deaths, according to researchers. Falls are a leading cause of injury and death in older adults. However, evidence for a link between opioid use and falls is inconsistent, the researcher said.

The findings showed that patients with opioid intake were 2.4 times more likely to have a fall causing injury.  “The study confirms an association between recent opioid use and fall-related injury in a large trauma population of older adults,” said a researcher.

Patients whose falls were linked to opioid use were also more likely to die during their hospital stay, the researchers said. “Physicians should be aware that prescribing opioids to older patients is not only associated with an increased risk of falls but also if these patients do fall, a higher in-hospital mortality rate,” the Dr. noted.

The study, published in the journal included data on 67,929 patients aged 65 and older who were admitted for injury to one of 57 trauma centres. The mean age of patients was 81 years, and the majority, 69 per cent, were women.

Falls were the most common cause of injury (92 per cent of patients), and more than half (59 per cent) had surgery for their injuries, with lengthy hospital stays (median stay of 12 days).

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Brain Study May Lead to New Ways to Control Pain without Opioids

Scientists say they have identified how the brain's natural painkilling system could be used as a possible alternative to opioids for the effective relief of chronic pain, which affects as many as one in three people at some point in their lives. 

The team, pinpointed an area of the brain that is important for endogenous analgesia—the brain's intrinsic pain relief system. They believe their study, could lead to the development of pain treatments that activate the painkilling system by stimulating this area of the brain, but without the dangerous side effects of opioids. 

“Tonic pain after injury characterizes a behavioural state that prioritizes recovery. Although generally suppressing cognition and attention, tonic pain needs to allow effective relief learning to reduce the cause of the pain. Here, we describe a central learning circuit that supports learning of relief and concurrently suppresses the level of ongoing pain. We used computational modelling of behavioural, physiological and neuroimaging data in two experiments in which subjects learned to terminate tonic pain in static and dynamic escape-learning paradigms,” write the investigators.

“In both studies, we show that active relief-seeking involves a reinforcement learning process manifest by error signals observed in the dorsal putamen. Critically, this system uses an uncertainty ('associability') signal detected in pregenual anterior cingulate cortex that both controls the relief learning rate, and endogenously and parametrically modulates the level of tonic pain. The results define a self-organizing learning circuit that reduces ongoing pain when learning about potential relief.”

Opioid drugs such as oxycodone, hydrocodone, and fentanyl hijack the endogenous analgesia system, which is what makes them such effective painkillers. However, they are also highly addictive, which has led to the opioid crisis in some countries, where drug overdose is now the leading cause of death for those under 50, with opioid overdoses representing two-thirds of those deaths. 

"We're trying to understand exactly what the endogenous analgesia system is: why we have it, how it works, and where it is controlled in the brain," said the Dr., who led the research. "If we can figure this out, it could lead to treatments that are much more selective in terms of how they treat pain."

"Pain can actually help us recover by removing our drive to do unnecessary things—in a sense, this can be considered 'healthy pain'. So why might the brain want to turn down the pain signal sometimes?"

The team thought that sometimes this "healthy pain" could be a problem, especially if we could actively do something that might help—such as try and find a way to cool a burn. In these situations, the brain might activate the pain-killing system to actively look for relief. To prove this, and to try and identify where in the brain this system was activated, the team designed a pair of experiments using brain-scanning technology. 

In the first experiment, the researchers attached a metal probe to the arm of a series of healthy volunteers and heated it up to a level that was painful, but not enough to physically burn them. The volunteers then played a type of gambling game where they had to find which button on a small keypad cooled down the probe. The level of difficulty was varied over the course of the experiments—sometimes it was easy to turn the probe off, and sometimes it was difficult. Throughout the task the volunteers frequently rated their pain, and the researchers constantly monitored their brain activity.

The results found that the level of pain the volunteers experienced was related to how much information there was to learn in the task. When the subjects were actively trying to work out which button they should press, pain was reduced. But when the subjects knew which button to press, it wasn't. The researchers found that the brain was actually computing the benefits of actively looking for and remembering how they got relief and using this to control the level of pain. 

Knowing what this signal should look like, the researchers then searched the brain to see where it was being used. The second experiment identified the signal in a single region of the prefrontal cortex, called the pregenual cingulate cortex. 

"These results build a picture of why and how the brain decides to turn off pain in certain circumstances, and identify the pregenual cingulate cortex as a critical 'decision center' controlling pain in the brain," said the Dr.

This decision center is a key place to focus future research efforts. In particular, the researchers are now trying to understand what the inputs are to this brain region, if it is stimulated by opioid drugs, what other chemical messenger systems it uses, and how it could be turned on as a treatment for patients with chronic pain.

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