Polypharmacy of Certain Medications Increases Likelihood of Concurrent Depression

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Prevalence of depression was doubled in individuals who used 3 or more medications with depression as a potential adverse effect.
Prevalence of depression was doubled in individuals who used 3 or more medications with depression as a potential adverse effect.

Polypharmacy of prescription medications with depression as a potential adverse effect may be associated with an increased likelihood of developing concurrent depression, according to a study published in JAMA.

Data from the 5 most recent 2-year cycles (2005 to 2006 through 2013 to 2014) of the National Health and Nutrition Examination Survey were evaluated for individuals with prescription drug use and depression. Associations between concurrent depression and the use of multiple prescription medications with depression as a potential adverse effect were further examined. Major depression in the participants was defined by a score of 10 or higher on the Patient Health Questionnaire 9.

The study sample included 26,192 US adults, of which an estimated 37.2% used at least 1 prescription drug with depression as a potential adverse effect. Prevalence of depression was doubled in individuals who used 3 or more medications with depression as a potential adverse effect: 15.3% of patients taking multiple medications vs 6.9% of subjects taking 1 medication reported depressive symptoms. These findings were consistent in the analyses of participants who used antihypertensive medications, proton pump inhibitors, analgesics, and hormonal contraceptives — many of these medication classes are available over-the-counter and do not include thorough information on depression as a potential adverse effect.

Limitations of the study included the inability to establish a causal relationship between medication use and the presence of depressive symptoms. In addition, the survey did not adjust for a history of depression, which could confound associations of medication use with depression. Another limiting factor was that only prescription medications were included in the survey, however, many over-the-counter medications also list depression as a potential adverse effect. Finally, the Micromedex software used to characterize medications may have excluded some medications that were associated with the risk for depression.

The study reported a significant association between the use of multiple prescription medications with depression as a potential adverse effect, with the development of concurrent depression. Physicians should discuss with their patients the potential risk for depression associated with certain prescriptions, and recommend screening individuals for depression in treatment follow-up.

Reference

Qato DM, Ozenberger K, Olfson M. Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States [published online June 12, 2018]. JAMA. doi: 10.1001/jama.2018.6741

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