A new study led by Dima Mazen Qato, PharmD, MPH, PhD, assistant professor of pharmacy systems, outcomes and policy at the University of Illinois at Chicago College of Pharmacy, examined the medication regimens of over 26,000 adults collected as part of the National Health and Nutrition Examination Survey from 2005 to 2014. The retrospective review identified hundreds of commonly used prescriptions drugs, including but not limited to, antihypertensive agents, proton pump inhibitors, and hormones that were associated with the increased risk of depression. And although these agents are already associated with intrinsic risk of depression side effects, the researchers demonstrated that concurrent use of multiple agents associated with depressive side effects carried a much greater risk. 

“The takeaway message of this study is that polypharmacy can lead to depressive symptoms and that patients and healthcare providers need to be aware of the risk of depression that comes with all kinds of common prescription drugs—many of which are also available over the counter,” said Qato. “Many may be surprised to learn that their medications, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms, and may lead to a depression diagnosis.”

Why is this important for hospital pharmacists? The research team notes that this study is the first to report that an exaggerated risk is more strongly associated with polypharmacy using combinations of multiple medications with depressive symptom risk. Pharmacists involved in medication reconciliation throughout the continuum of care should always seek to reduce polypharmacy when clinically possible, not only to reduce pill burden when the patient is discharged, but also to lessen the chance of drug-induced depression. The study confirmed that of the patients using combinations of medications with associated depression symptom side effects, roughly 15% of the study population affected by depressive side effects were taking at least three of the medications concomitantly versus 9% who were taking two medications concurrently, 7% who were taking one medication daily, and 5% for individuals not taking any medication.  

The authors highlight that future medication reconciliation and assessment should include proactive screening for combinations of drugs with depressive side effects. “With depression as one of the leading causes of disability and increasing national suicide rates, we need to think innovatively about depression as a public health issue, and this study provides evidence that patterns of medication use should be considered in strategies that seek to eliminate, reduce or minimize the impact of depression in our daily lives,” Qato said.

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