Several categories of drugs have been implicated in causing drug-induced depression. Because many symptoms of depression such as sleep changes, fatigue, and GI problems also occur as adverse effects of several medications, linking a depressive spectrum disorder to a medication is difficult. The temporal relationship of the medication to the depressive symptoms, however, is helpful in establishing a diagnosis of drug-induced depression.
Known properties of certain medications also form a relationship with our current understanding of how our nervous system contributes to mood disorders. It has generally been found that drug-induced depression is likelier to occur in those with risk factors for developing dysthymia and major depressive disorder (MDD), such as those with a personal or family history of depression.
According to the Diagnostic and Statistical Manual of Mental Disorders, the lifetime risk for MDD ranges from 10-25 percent in women and from 5-12 percent in men. Clinical depression is associated with a lifetime incidence of suicide of approximately 15%. The prevalence of MDD at any given time is estimated at 5-9 percent among women and 2-3 percent among men. The loss of productivity and wages due to depression is estimated at millions of dollars annually.
In the category of organic mood disorder, depressed type, drugs are implicated as the probable cause in ten percent of patients. Older patients are likelier to take more medications and are therefore likelier to experience drug-induced depression.
Drugs with some substantiation of a link to depression include:
- Minor tranquilizers
- Interferon beta-1b, peginterferon alfa-2b
- Propranolol and nadolol
- Isotretinoin (ACCUTANE)
- Antidepressants such as citalopram, escitalopram, bupropion, fluoxetine (PROZAC), fluvoxamine, mirtazapine, nefazodone, sertraline (ZOLOFT), venlafaxine, paroxetine (PAXIL)
Potential complications of idiosyncratic drug-induced depression include:
- Homicidal behavior
- Interpersonal problems
- Loss of work time
- Prolonged hospital stays
If discontinuation of the offending drug or agent is possible, it should be done so immediately when drug-induced depression is suggested. If the symptoms and depressed mood does not subside within four weeks, other causes should be considered.
Suicide risk should be regularly assessed in any patient with depression. Risk factors for suicide include agitation, psychosis, recent psychiatric admission, past suicide attempts, and a family history of suicide. If the patient is suicidal, his or her depressive symptoms are severe, or psychosis is suspected, a mental health professional should be consulted and intensive inpatient or outpatient care may need to be considered.
Suicidal ideation varies from fleeting to detailed planning and role-playing. While most people who think about committing suicide do not actually do so, some make attempts albeit deliberately intended to fail, but others eventually succeed. Any discussion of suicidal intent should be taken seriously.