Chronic Illness also Can Contribute to Depression
Many medications list depression as a side effectbut the evidence linking a particular medication to depression isn't always conclusive. And because depression is common in people who have certain chronic illnesses, it's often difficult for doctors to determine whether a particular medication is to blame or if a patient's depressed state results from the illness itself.
However, a clinical review did find strong evidence that certain medications do indeed cause depression in some patients. The review, published in 2011 in the journal Dialogues in Clinical Neuroscience, noted that these medications should be used cautiously in people with current or prior depression, or those who are otherwise at high risk for depression:
- vigabatrin (Sabril)
- topiramate (Topamax)
- efavirenz (Sustiva)
Some of these medications may cause depressive symptoms directly by altering levels of neurotransmitters in the central nervous system. Others may do so indirectly by causing fatigue, diminished appetite, sedation or other side effects, which can lead to depression. For example, many cardiovascular drugs have been shown to cause fatigue and sedation at rates greater than with a placebo.
It's important to let your doctor know if you experience a depressive episode while taking any of the medications on the list. If your doctor determines that your symptoms are related to a medication or combination of medications you're taking, he or she may alter the dosage or switch you to another drug or combination. But don't stop taking a medication without your doctor's approval.
Other Drugs and Depression Risk
The review noted that for medications other than those listed above, studies linking depression to medication use have been limited, based mostly on case reports and case series, and not on well-controlled trialsmeaning the evidence isn't as strong. These medications include drugs prescribed to treat illnesses that are themselves associated with an increased risk of depression, such as Alzheimer's disease, Parkinson's disease and epilepsy.
Classes of medications that may contribute to depression or depressive symptoms include:
- Alzheimer's disease drugs such as donepezil (Aricept) and rivastigmine (Exelon)
- Anti-androgens such as bicalutamide (Casodex) and nilutamide (Nilandron)
- Anti-convulsants such as carbamazepine (Tegretol), lamotrigine (Lamictal) and zonisamide (Zonegran)
- Benzodiazepines such as alprazolam (Xanax), diazepam (Valium), estazolam (ProSom) and lorazepam (Ativan)
- Beta-blockers such as atenolol (Tenormin), propanolol (Inderal) and timolol (Timoptic)
- Calcium channel blockers such as diltiazem (Cardizem, Dilacor and others) and verapamil (Calan)
- Hormone replacement therapies such as estrogen (Cenestin, Enjuvia and others), medroxyprogesterone (Provera) and conjugated estrogens/medroxyprogesterone (Prempro)
- Parkinson's disease medications such as amantadine and levodopa/carbidopa (Parcopa, Sinemet)
- Other medications such as clonidine (Catapres, Duraclon), clopidogrel (Plavix) and raloxifene (Evista)
Even when depression is listed as a rare side effect of a medication, be aware that the risk of the medication triggering depression may increase with age because of changing body chemistry. Medication-related depression is also a greater risk for people with a history of mood disorders and those who are taking multiple medications.