One-Third of U.S. Adults May Unknowingly Use Medications That Increase Depression Risk

Summary: Researchers report that nearly one in three American adults use prescription medicines that can increase the risk of depression or suicidal thoughts—often without realizing it.

Source: University of Illinois.

Overview

A new analysis by researchers at the University of Illinois at Chicago shows that a large portion of U.S. adults take prescription medications that list depression or suicidal ideation as potential adverse effects. Because many of these drugs treat conditions unrelated to mood—such as heart disease, acid reflux or contraception—patients and some health care providers may not associate them with new or worsening depressive symptoms.

The team reviewed medication use reported by more than 26,000 adults who participated in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2014. They identified more than 200 commonly used prescription drugs that include depression or suicide on their adverse effect profiles. These drugs range from hormonal contraceptives and blood pressure medicines to proton pump inhibitors, antacids and pain relievers.

Key Findings

Published in the Journal of the American Medical Association (JAMA), the study highlights two main concerns: the widespread use of medications that can cause depression, and the growing phenomenon of polypharmacy—using multiple such medications at the same time.

Major results include:

• Overall, an estimated 37.2% of adults used at least one prescription medication that lists depression as a potential adverse effect. This increased from about 35.0% in 2005–2006 to 38.4% in 2013–2014.
• The proportion of adults using three or more such medications concurrently rose from 6.9% in 2005–2006 to 9.5% in 2013–2014.
• Use of medications that list suicide as a potential side effect increased from 17% to 24% across the study period, with concurrent use of three or more of these drugs rising from roughly 2% to 3%.
• Among adults not taking antidepressants, 15% of those using three or more medications with depression as a potential adverse effect screened positive for depression (PHQ-9 score ≥10), compared with 4.7% of adults not using any such medications. Similar patterns were observed after excluding psychotropic drug users and in analyses limited to adults with hypertension or those taking antidepressants.

Implications

Lead author Dima Qato, an assistant professor in the UIC College of Pharmacy, emphasizes that many patients and clinicians may not be aware that widely prescribed medicines can contribute to depressive symptoms. The study indicates that the risk grows when multiple medications with similar adverse effects are used at the same time.

Qato and colleagues point out that few of these medications carry explicit warnings about depression or suicidal thoughts, so awareness and screening rely heavily on clinicians and patients. The researchers suggest system-level interventions, such as updating drug interaction and safety software to flag depression risk from multiple medications and including medication reviews in depression screening and diagnostic procedures—especially for persistent or treatment-resistant depression.

Recommendations

The authors recommend several practical steps to reduce unintended harm:

• Improve medication safety tools so they recognize depression and suicidal ideation as potential drug-drug interactions and alert prescribers and pharmacists when multiple risky medications are combined.
• Incorporate systematic medication reviews into depression screening and diagnostic protocols used by primary care providers, mental health clinicians and public health programs.
• Raise patient and clinician awareness that common over-the-counter and prescription medicines can affect mood, and encourage open discussion about new or worsening depressive symptoms after starting or combining treatments.

Study Details and Authors

The cross-sectional study analyzed five two-year cycles (2005–2006 through 2013–2014) of NHANES data. The sample included 26,192 adults (mean age 46.2 years; 51.1% women). Overall depression prevalence (PHQ-9 ≥10) was 7.6%. The analysis identified medication use patterns, concurrent use of medications with depression as a possible adverse effect, and associations with current depressive symptoms using multivariable logistic regression.

Co-authors include Katharine Ozenberger and Mark Olfson. The research appears in JAMA under the title “Prevalence of Prescription Medications With Depression as a Potential Adverse Effect Among Adults in the United States.” The study’s findings underscore the need to consider common medication patterns when addressing depression and suicide risk at both the individual and population levels.

This research highlights medication-related contributors to depressive symptoms and suggests changes in clinical practice and health IT to better identify and mitigate those risks. With depression a leading cause of disability and rising suicide rates nationally, recognizing medication effects is an important step in public health strategies to reduce the burden of mood disorders.