Depression and suicide risk are side-effects in too many common drugs

pills-300x200Patients, doctors, and pharmacists may want to be more wary about more than 200 commonly prescribed drugs that not only treat an array of medical conditions but also carry depression and suicide risk as side effects. More than a third of Americans take the medications, and they report higher depression rates than those who don’t, with their risks increasing as they add in more of these drugs, a new study finds.

The medications, researchers said, are seemingly ubiquitous, and polypharmacy ── patients taking multiple drugs for different conditions at the same time ── with the depression- and suicide-risk meds is frequent in an alarming fashion.  As NPR, the New York Times, and the news site Vox reported, the drugs include:

  • Certain types of proton pump inhibitors (PPIs) used to treat acid reflux. These are sold, by prescription and over the counter, under brand names like Prilosec and Zantac.
  • Anxiety drugs, including those sold under the brand name Xanax
  • Beta blockers used to treat heart ailments, high blood pressure, anxiety and migraine headaches
  • Many painkillers, including prescription-strength ibuprofen
  • Corticosteroids like prednisone used to treat an array of conditions including asthma, gout, hives, vasculitis, as well as nerve and kidney disorders
  • So-called ACE inhibitors used to treat high blood pressure
  • Anti-convulsant drugs like gabapentin
  • And birth control pills and emergency contraceptives

Dima Mazen Qato, an assistant professor and pharmacist at the University of Illinois at Chicago who was the lead author of the paper, published in JAMA, told the New York Times:  “It was both surprising and worrisome to see how many medications have depression or suicidal symptoms as a side effect, given the burden of depression and suicide rates in the country.” As the paper noted, the researchers said they have many unanswered questions, and their work points to a correlation, not a cause-and-effect relationship, or as Qato told the New York Times: “We didn’t prove that using these medications could cause someone who was otherwise healthy to develop depression or suicidal symptoms. But we see a worrisome dose-response pattern: The more of these medications that have these adverse effects that you’re taking concurrently, the higher the risk of depression.”

The folks over at healthnewsreview.org, an independent, nonpartisan watchdog site of health and medical news reporting, raised other flags about the new drug study. They recently posted helpful information in how savvy consumers (and journalists) can better sort out studies that rely on association, observation, and causation ── and avoiding jumping to bad conclusions. They had greater concern, though, with the drug study because it relies so much on patients self-reporting their mental state ── whether they were depressed or not. They did so with an old, simple, unhelpful, and unrevealing questionnaire. That tool was developed by a drug maker hawking a product for patients with depression, a condition the profit-seeking company likely would want to be more rather than less pronounced and prevalent.

And, while it is true that Big Pharma ── for once ── has hardly hidden the depression and suicide-risk side effects of most of the drugs spotlighted by the researchers, and doctors, pharmacists, and patients likely had information on them,  it is well worth reminding all parties of the risks of polypharmacy. Seniors, in particular, have heightened risk of their various doctors prescribing them too many drugs, too often without knowing all the meds and supplements patients already are taking and how the dangerous ways they might interact. Pharmacists can be helpful in averting prescription problems. But too many patients go to multiple, different drug stores or providers to get prescriptions filled.

Doctors, pharmacists, and other medical caregivers also must take note of federal officials’ new warning that the nation now faces a public health crisis with rising numbers of suicides, including the self-inflicted deaths of notables like culinary adventurer Anthony Bourdain and fashion entrepreneur Kate Spade. Self-inflicted deaths have spiked across the nation, and across age, gender, race and ethnicity.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.

Meantime, depression ── a leading mental disorder implicated in many suicides ── also poses  challenges to tens of millions of Americans who suffer such persistent sadness, isolation, loneliness, anxiety, fear, and hopelessness that it disrupts their lives. Federal officials’ data show that one in nine Americans of all ages, between 2011 and 2014, reported taking at least one antidepressant medication in the past month. That compares with 1 in 50 who did so three decades ago.

In my practice, I see not only the harms that patients suffer while seeking medical services but also their struggles to access and afford safe, effective, and excellent medical care, including for their mental health. We’ve clearly got significant and unanswered needs for mental health care in this country, and excessive prescribing of Big Pharma’s profit-boosting pills isn’t the only answer.

Americans are only just beginning to come to grips with even more disclosures about Big Pharma’s ugly role in fostering a lethal opioid drug crisis, including new evidence on how abuse of injectable drugs is increasing hospitals’ costs and problems with outbreaks of MRSA, methicillin-resistant bacterial infections that are hard to treat with many available antibiotics. We need more study about drugs and their side- and direct- effects on depression and suicide. It will be grim news if Big Pharma’s implicated here, too.

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