There is nothing more frustrating than when the cure is part of the problem. Because depression is prevalent in patients with physical disorders like cancer, stroke, and heart disease, medications often interact with each other, complicating treatment. To appropriately manage depression, you and your physician need to evaluate all medications involved and make sure they aren’t cancelling each other out.
A review in the journal Dialogues in Clinical Neuroscience a while back highlighted certain medications that can cause depression. The following are medications to watch out for.
Medications to Treat Seizures and Parkinson’s Disease
Many anticonvulsants have been linked with depression, but three medications — barbiturates, vigabatrin, and topiramate — are especially guilty. Because they work on the GABA neurotransmitter system, they tend to produce fatigue, sedation, and depressed moods. Other anticonvulsants, including tiagabine, zonisamide, levetiracetam, and felbamate have been associated in placebo-controlled trials with depressive symptoms in patients. Patients at high risk for depression should be monitored closely when prescribed barbiturates, vigabatrin, or topiramate. When treating Parkinson’s disease, caution should be taken when using levodopa or amantadine, as they may increase depressive symptoms.
Medications to Treat Migraines
In migraine patients at risk for depression, topiramate and flunarizine should be avoided when possible. A better option is acute treatment with serotonin agonists and prophylactic treatment with TCAs, as those medications could simultaneously address symptoms of both depression and migraine headaches.
Certain headache medications like Excedrin that list caffeine as an ingredient can also worsen anxiety.
The link between blood pressure medications and depression has been well established. By affecting the central nervous system, methyldopa, clonidine, and reserpine may aggravate or even cause depression. Beta-blockers like atenolol and propranolol may also have depression side effects.
Although low cholesterol has been associated with depression and suicide, there is no clear link between depression and lipid-lowering agents.
Antibiotic and Cold Medications
Although most antibiotics used to treat infections are unlikely to cause depression, there have been some cases in which they induce symptoms. Anti-infective agents, such as cycloserine, ethionamide, metronidazole, and quinolones, have been linked to depression.
Over-the-counter cold medications like Sudafed that contain the decongestant pseudo-ephedrine can contribute to anxiety.
Antidepressants and Anti-Anxiety Medication
Sometimes medications to treat depression and anxiety can have a reverse effect, especially in the first few weeks of treatment. There have been reports of Lexapro, for example, worsening anxiety, however it usually subsides after the first few weeks. Anecdotal evidence suggests that Wellbutrin may also cause anxiety.
Approximately 10 to 25 percent of cancer patients develop significant depressive symptoms, however, given that so many medications are involved in treating cancer, it can been difficult to pinpoint the culprits. Vinca alkaloids (vincristine and vinblastine) inhibit the release of dopamine-ß-hyroxylase, and have been linked to irritability and depression. The cancer drugs procarbazine, cycloserine, and tamoxifen are also considered to induce depression.
One report cited depression in 16 percent of carmustine-treated patients, and 23 percent in those receiving busulfan when employed as part of the treatment for stem cell transplants. The antimetabolites pemetrexed and fludarabine have been reported to cause mood disturbances. Some hormonal agents to treat breast cancer have also been associated with depression, including tamoxifen and anastrozole. Finally, taxane drugs such as paclitaxel and docetaxel have been linked to depression.
Oral Contraceptives and Infertility Medications
Oral contraceptive medications have long been associated with depression. In a study published in the British Medical Journal, of the group of women taking oral contraceptives, 6.6 percent were more severely depressed than the control group. GnRH agonists (such as leuprolide and goserelin) can have depression side-effects in some people. In one study, 22 percent of leuprolide-treated patients and 54 percent of goserelin-treated patients suffered from significant depressive symptoms. Clomiphene citrate, a selective estrogen receptor modulator used to induce ovulation, has also been associated with depressed mood.