Abstract
Background: Certain medications may contribute to the etiology of depressive symptoms and disorders. Research in this area, however, has been hampered by methodological and conceptual problems. This review had two objectives: to identify evidence linking medical drugs to depressive symptoms and disorders, and to summarize this evidence in a clinically meaningful way. Methods: Electronic literature searches were performed and studies were reviewed with reference to critical methodological features. Results: No medications causing the typical major depressive syndrome were identified. Evidence was found linking corticosteroids, interferon-α, interleukin-2, gonadotropin-releasing hormone agonists, mefloquine, progestin-releasing implanted contraceptives and propranolol to the etiology of atypical depressive syndromes. Conclusions: A small number of drugs have been shown capable of inducing depressive symptoms. Drug-induced depression appears to differ symptomatically from classical major depression.
References
1.
Freemantle SN, Pearce GL, Wilton LV, MacKay FJ, Mann RD: The incidence of the most commonly reported events with 40 newly marketed drugs – A study by prescription-event monitoring. Pharmacoepidemiol Drug Saf 1997;6(Suppl 1):1–62.
2.
Australian Government DoHaATGA: Depression – Could it be the drug? Canberra, Australian Adverse Drug Reactions Bulletin, 1998, vol 17, No 1.
3.
Ananth J, Ghadirian AM: Drug-induced mood disorders. Int Pharmacopsychiatry 1980;15:59–73.
4.
Beers MH, Passman LJ: Antihypertensive medications and depression. Drugs 1990;40:792–799.
5.
Gangat AE, Simpson MA, Naidoo LR: Medication as a potential cause of depression. S Afr Med J 1986;70:224–226.
6.
Ganzini L, Walsh JR, Millar SB: Drug-induced depression in the aged. What can be done? Drugs Aging 1993;3:147–158.
7.
Klysner R: Drug-induced depression. Pharmacol Toxicol 1992;71(Suppl 1):107–112.
8.
Patten SB, Love EJ: Drug-induced depression. Incidence, avoidance and management. Drug Saf 1994;10:203–219.
9.
Patten SB, Love EJ: Drug-induced depression. Psychother Psychosom 1997;66:63–73.
10.
Popkin MK, Tucker GJ: ‘Secondary’ and drug-induced mood, anxiety, psychotic, catatonic, and personality disorders: A review of the literature. J Neuropsychiatry Clin Neurosci 1992;4:369–385.
11.
Wood KA, Harris MJ, Morreale A, Rizos AL: Drug-induced psychosis and depression in the elderly. Psychiatr Clin North Am 1988;11:167–193.
12.
Rothman KJ: Causes. Am J Epidemiology 1976;104:587–592.
13.
Goble AJ: Beta-blocker treatment and depression. Arch Intern Med 1992;152:649.
14.
Healy D, Savage M: Reserpine exhumed. Br J Psychiatry 1998;172:376–378.
15.
Palinkas LA, Wingard DL, Barrett-Connor E: Chronic illness and depressive symptoms in the elderly: A population-based study. J Clin Epidemiol 1990;43:1131–1141.
16.
Schleifer SJ, Slater WR, Macari-Hinson MM, Coyle DA, Kahn M, Zucker HD, Gorlin R: Digitalis and beta-blocking agents: Effects on depression following myocardial infarction. Am Heart J 1991;121:1397–1402.
17.
Patten SB, Williams JVA, Love EJ: Self-reported depressive symptoms following treatment with corticosteroids and sedative-hypnotics. Int J Psychiatry Med 1996;26:15–24.
18.
Dhondt ADF, Hooijer C, Smit JH, van Tilburg W: Drug-associated depression is not major depressive disorder: A pilot study in a population-based sample of the elderly. Int J Geriatr Psychiatry 1996;11:141–148.
19.
Ried LD, Johnson RE, McFarland BH, Brody KK: Antihypertensive drug use and the risk of depression among older hypertensives in an HMO. J Pharmacoepidemiol 2000;8:1–28.
20.
Patten SB, Williams JV, Love EJ: Self-reported depressive symptoms in association with medication exposures among medical inpatients: A cross-sectional study. Can J Psychiatry 1995;40:264–269.
21.
Patten SB, Lavorato DH: Medication use and major depressive syndrome in a community population. Compr Psychiatry 2001;42:124–131.
22.
Tyrer PJ: Drug-induced depression. Prescr J 1981;21:237–242.
23.
Ng CH, Tam MM, Celi E, Tate B, Schweitzer I: Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy. Australas J Dermatol 2002;43:262–268.
24.
Prisant LM, Spruill WJ, Fincham JE, Wade WE, Carr AA, Adams MA: Depression associated with antihypertensive drugs. J Fam Pract 1991;33:481–485.
25.
Snaith RP, McCoubrie M: Antihypertensive drugs and depression. Psychol Med 1974;4:393–398.
26.
Bant WP: Antihypertensive drugs and depression: A reappraisal. Psychol Med 1978;8:275–283.
27.
DeMuth GW, Ackerman SH: α-Methyldopa and depression: A clinical study and review of the literature. Am J Psychiatry 1983;140:534–538.
28.
Goble AJ: β-Blocker treatment and depression. Arch Intern Med 1992;152:649.
29.
Gerstman BB, Jolson HM, Bauer M, Cho P, Livingston JM, Platt R: The incidence of depression in new users of beta-blockers and selected antihypertensives. J Clin Epidemiol 1996;49:809–815.
30.
Bright RA, Everitt DE: Beta-blockers and depression. Evidence against an association. JAMA 1992;267:1783–1787.
31.
Avorn J, Everitt DE, Weiss S: Increased antidepressant use in patients prescribed beta-blockers. JAMA 1986;255:357–360.
32.
Thiessen BQ, Wallace SM, Blackburn JL, Wilson TW, Bergman U: Increased prescribing of antidepressants subsequent to beta-blocker therapy. Arch Int Med 1990;150:2286–2290.
33.
Johnson JA, Wallace SM: Investigating the relationship between beta-blocker and antidepressant use through linkage of the administrative databases of Saskatchewan Health. Pharmacoepidemiol Drug Saf 1997;6:1–11.
34.
Rathmann W, Haastert B, Roseman JM, Giani G: Cardiovascular drug prescriptions and risk of depression in diabetic patients. J Clin Epidemiol 1999;52:1103–1109.
35.
Stoudemire A, Brown JT, Harris RT, Blessing-Feussner C, Roberts JH, Nichols JC, Houpt JL: Propranolol and depression: A reevaluation based on a pilot clinical trial. Psychiatr Med 1984;2:211–218.
36.
Bartels D, Glasser M, Wang A, Swanson P: Association between depression and propranolol use in ambulatory patients. Clin Pharm 1988;7:146–150.
37.
Carney RM, Rich MW, teVelde A, Saini J, Clark K, Freedland KE: Prevalence of major depressive disorder in patients receiving beta-blocker therapy versus other medications. Am J Med 1987;83:223–226.
38.
Adler L: CNS effects of beta blockade: A comparative study. Psychopharmacol Bull 1988;24:232–237.
39.
Lorr M, McNair DM, Fisher SU: Evidence for bipolar mood states. J Pers Assess 1982;46:432–436.
40.
Head A, Kendall MJ, Ferner R, Eagles C: Acute effects of β blockade and exercise on mood and anxiety. Br J Sports Med 1996;30:238–242.
41.
Conant J, Engler R, Janowsky D, Maisel A, Gilpen E, LeWinter M: Central nervous system side effects of β-adrenergic blocking agents with high and low lipid solubility. J Cardiovasc Pharm 1989;13:656–661.
42.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:53–63.
43.
Duch S, Duch C, Pasto L, Ferrer P: Changes in depressive status associated with topical beta-blockers. Int Ophthalmol 1992;16:331–335.
44.
Zung WWK: A self-rating depression scale. Arch Gen Psychiatry 1965;12:63–70.
45.
Sorgi P, Ratey J, Knoedler D, Arnold W, Cole L: Depression during treatment with beta-blockers: Results from a double-blind placebo-controlled study. J Neuropsychiatry Clin Neurosci 1992;4:187–189.
46.
Perez-Stable EJ, Halliday R, Gardiner PS, Baron RB, Hauck WW, Acree M, Coates TJ: The effects of propranolol on cognitive function and quality of life: A randomized trial among patients with diastolic hypertension. Am J Med 2000;108:359–365.
47.
Kostis JB, Rosen RC, Holzer BC, Randolph C, Taska LS, Miller MH: CNS side effects of centrally active antihypertensive agents: A prospective, placebo-controlled study of sleep, mood state, and cognitive and sexual function in hypertensive males. Psychopharmacology 1990;102:163–170.
48.
Croog SH, Levine S, Testa MA, Brown B, Bulpitt CJ, Jenkins CD, Klerman GL, Williams GL: The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986;314:1657–1664.
49.
Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM: Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 2002;288:351–357.
50.
Patten SB: Propranolol and depression, evidence from the antihypertensive trials. Can J Psychiatry 1990;35:257–259.
51.
The β-Blocker Evaluation of Survival Trial Investigators: A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001;344:1659–1667.
52.
Boston Collaborative Drug Surveillance Program: Psychiatric side effects of nonpsychiatric drugs. Semin Psychiatry 1971;3:406–420.
53.
Gift AG, Wood RM, Cahill CA: Depression, somatization and steroid use in chronic obstructive pulmonary disease. Int J Nurs Stud 1989;26:281–286.
54.
Patten SB, Williams JVA, Love EJ: Self-reported depressive symptoms in association with medication exposures among medical inpatients: A cross-sectional study. Can J Psychiatry 1995;40:264–269.
55.
Patten SB: Exogenous corticosteroids and major depression in the general population. J Psychosom Res 2000;49:447–449.
56.
Naber D, Sand P, Heigl B: Psychopathological and neuropsychological effects of 8-days’ corticosteroid treatment. A prospective study. Psychoneuroendocrinology 1996;21:25–31.
57.
Wolkowitz OM: Prospective controlled studies of the behavioral and biological effects of exogenous corticosteroids. Psychoneuroendocrinology 1994;19:233–255.
58.
Neutel CI: A new, ‘user-friendly’ terminology for confounding by indication in the study of adverse drug reactions. Post-Marketing Surveillance 1993;7:363–369.
59.
Hall RCW, Popkin MK, Kirkpatrick B: Tricyclic exacerbation of steroid psychosis. J Nerv Ment Dis 1978;166:738–742.
60.
Yoshimura R, Ueda N, Nakamura J: Successful treatment of steroid-induced depression with low dosage of fluvoxamine. Aust N Z J Psychiatry 2001;35:855–856.
61.
Wyszynski AA, Wyszynski B: Treatment of depression with fluoxetine in corticosteroid-dependent central nervous system Sjogren’s syndrome. Psychosomatics 1993;34:173–177.
62.
Terao T, Yoshimura R, Shiratuchi T, Abe K: Effects of lithium on steroid-induced depression. Biol Psychiatry 1997;41:1225–1226.
63.
Siegal FP: Lithium for steroid-induced psychosis. N Engl J Med 1978;299:155–156.
64.
Falk WE, Mahnke MW, Poskanzer DC: Lithium prophylaxis of corticotrophin-induced psychosis. JAMA 1979;241:1011–1012.
65.
Goggans FC, Weisberg LJ, Koran LM: Lithium prophylaxis of prednisone psychosis: A case report. J Clin Psychiatry 1983;44:111–112.
66.
Brown ES, Frol A, Bobadilla L, Nejtek VA, Perantie DC, Dhillon H: Effect of lamotrigine on mood and cognition in patients receiving chronic exogenous corticosteroids. Psychosomatics 2003;44:204–208.
67.
Brown ES, Khan DA, Suppes T: Treatment of corticosteroid-induced mood changes with olanzapine. Am J Psychiatry 1999;156:968.
68.
Terao T: Lithium therapy for corticosteroid-induced mood disorder. J Clin Psychiatry 2001;62:57–58.
69.
Warnock JK, Bundren JC: Anxiety and mood disorders associated with gonadotropin-releasing hormone agonist therapy. Psychopharmacol Bull 1997;33:311–316.
70.
Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278–296.
71.
Toren P, Dor J, Mester R, Mozes T, Blumensohn R, Rehavi M, Weizman A: Depression in women treated with a gonadotropin-releasing hormone agonist. Biol Psychiatry 1996;39:378–382.
72.
Warnock JK, Bundren JC, Morris DW: Depressive mood symptoms associated with ovarian suppression. Fertil Steril 2000;74:984–986.
73.
Patten SB, Williams JVA, Love EJ: H-2 Blocker exposure as a risk factor for depression. Can J Psychiatry 1996;41:537–538.
74.
Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.
75.
Robins AH, Lucke W, McFadyen ML, Wright JP: Effect of the H2-receptor antagonist ranitidine on depression and anxiety in duodenal ulcer patients. Postgrad Med J 1984;60:353–355.
76.
Boumendil E, Tubert-Bitter P: Depression-induced absenteeism in relation to antihyperlipidemic treatment: A study using GAZEL cohort data. Epidemiology 1995;6:322–325.
77.
Lindberg G, Hallas J: Cholesterol-lowering drugs and antidepressants – A study of prescription symmetry. Pharmacoepidemiol Drug Saf 1998;7:399–402.
78.
Kassler-Taub K, Woodward T, Markowitz JS: Depressive symptoms and pravastatin. Lancet 1993;341:371–372.
79.
Wardle J, Armitage J, Collins R, Wallendszus K, Keech A, Lawson A: A randomised placebo-controlled trial of the effect on mood of lowering cholesterol concentration. Br Med J 1996;313:75–78.
80.
Harrison RW, Ashton CH: Do cholesterol-lowering agents affect brain activity? Comparison of simvastatin, pravastatin, and placebo in healthy volunteers. Br J Clin Pharmacol 1994;37:231–236.
81.
Westhoff C, Truman C, Kalmuss D, Cushman L, Rulin M, Heartwell S, Davidson A: Depressive symptoms and Norplant contraceptive implants. Contraception 1998;57:241–245.
82.
Radloff LS: The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385–401.
83.
Civic D, Scholes D, Ichikawa L, LaCroix AZ, Yoshida CK, Ott SM, Barlow WE: Depressive symptoms in users and non-users of depot medroxyprogesterone acetate. Contraception 2000;61:385–390.
84.
Lawrie TA, Hofmeyr GJ, De Jager M, Berk M, Paiker J, Viljoen E: A double-blind randomised placebo-controlled trial of postnatal norethisterone enanthate: The effect on postnatal depression and serum hormones. Br J Obstet Gynaecol 1998;105:1082–1090.
85.
Bonaccorso S, Marino V, Biondi M, Grimaldi F, Ippoliti F, Maes M: Depression induced by treatment with interferon-alpha in patients affected by hepatitis C virus. J Affect Disord 2002;72:237–241.
86.
Castera L, Zigante F, Bastie A, Buffet C, Dhumeaux D, Hardy P: Incidence of interferon alfa-induced depression in patients with chronic hepatitis C. Hepatology 2002;35:978–979.
87.
Hosoda S, Takimura H, Shibayama M, Kanamura H, Ikeda K, Kumada H: Psychiatric symptoms related to interferon therapy for chronic hepatitis C: Clinical features and prognosis. Psychiatry Clin Neurosci 2000;54:565–572.
88.
Mulder RT, Ang M, Chapman B, Ross A, Stevens IF, Edgar C: Interferon treatment is not associated with a worsening of psychiatric symptoms in patients with hepatitis C. J Gastroenterol Hepatol 2000;15:300–303.
89.
Pariantes CM, Carpiniello B, the Cagliari Group: Interferon alfa-induced adverse effects in patients with a psychiatric diagnosis. N Engl J Med 2002;347:148–149.
90.
Okanoue T, Sakamoto S, Itoh Y, Minami M, Yasui K, Sakamoto M, Nishioji K, Katagishi T, Nakagawa Y, Tada H, Sawa Y, Mizuno M, Kagawa K, Kashima K: Side effects of high-dose interferon therapy for chronic hepatis C. J Hepatol 1996;25:283–291.
91.
Malaguarnera M, Di Fazio, I, Restuccia S, Pistone G, Ferlito L, Rampello L: Interferon alpha-induced depression in chronic hepatitis C patients: Comparison between different types of interferon alpha. Neuropsychobiology 1998;37:93–97.
92.
Hauser P, Khosla J, Aurora H, Laurin J, Kling MA, Hill J, Gulati M, Thornton AJ, Schultz RL, Valentine AD, Meyers CA, Howell CD: A prospective study of the incidence and open-label treatment of interferon-induced major depressive disorder in patients with hepatitis C. Mol Psychiatry 2002;7:942–947.
93.
Yates WR, Gleason O: Hepatitis C and depression. Depress Anxiety 1998;7:188–193.
94.
Schramm TM, Lawford BR, Macdonald GA, Cooksley WGE: Sertraline treatment of interferon-alfa-induced depressive disorder. Med J Aust 2000;173:359–361.
95.
Kraus MR, Schafer A, Faller H, Csef H, Scheurlen M: Paroxetine for the treatment of interferon-alpha-induced depression in chronic hepatitis C. Aliment Pharmacol Ther 2002;16:1091–1099.
96.
Farah A: Interferon-induced depression treated with citalopram. J Clin Psychiatry 2002;63:166–167.
97.
Levenson JL, Fallon HJ: Fluoxetine treatment of depression caused by interferon-alpha. Am J Gastroenterol 1993;88:760–761.
98.
Goldman LS: Successful treatment of interferon alfa-induced mood disorder with nortriptyline. Psychosomatics 1994;35:412–413.
99.
Hauser P, Soler R, Reed S, Kane R, Gulati M, Khosla J, Kling MA, Valentine AD, Meyers CA: Prophylactic treatment of depression induced by interferon-alpha. Psychosomatics 2000;41:439–441.
100.
Musselman DL, Lawson DH, Gumnick JF, Manatunga AK, Penna S, Goodkin RS, Greiner K, Nemeroff CB, Miller AH: Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med 2001;344:961–966.
101.
Capuron L, Raison CL, Musselman DL, Lawson DH, Nemeroff CB, Miller AH: Association of exaggerated HPA axis response to the initial injection of interferon-alpha with development of depression during interferon-alpha therapy. Am J Psychiatry 2003;160:1342–1345.
102.
European Study Group on Interferon β-1b in Secondary Progressive MS: Placebo-controlled multicentre randomised trial of interferon β-1b in treatment of secondary progressive multiple sclerosis. Lancet 1998;352:1491–1497.
103.
Patten SB, Metz LM: Interferon beta-1a and depression in relapsing-remitting multiple sclerosis: An analysis of depression data from the PRISMS clinical trial. Mult Scler 2001;7:243–248.
104.
Patten SB, Metz LM: Interferon beta1a and depression in secondary progressive MS: Data from the SPECTRIMS Trial. Neurology 2002;59:744–746.
105.
Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, et al: Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol 1996;39:285–294.
106.
Jacobs LD, Beck RY, Simon JH, Kinkel RP, Brownsheidle CM, Murray TJ, Simonian NA, Slasor PJ, Sandrock AW: Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med 2000;343:898–904.
107.
Borràs C, Rio J, Porcel J, Barrios M, Tintoré M, Montalban X: Emotional state of patients with relapsing-remitting MS treated with interferon beta-1b. Neurology 1999;52:1636–1639.
108.
Zephir H, De Seze J, Stojkovic T, Delisse B, Ferriby D, Cabaret M, Vermersch P: Multiple sclerosis and depression: Influence of interferon β therapy. Mult Scler 2003;9:284–288.
109.
Feinstein A, O’Connor P, Feinstein K: Multiple sclerosis, interferon beta-1b and depression A prospective investigation. J Neurol 2002;249:815–820.
110.
Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–370.
111.
Walker LG, Walker MB, Heys SD, Lolley J, Wesnes K, Eremin O: The psychological and psychiatric effects of rIL-2 therapy: A controlled clinical trial. Psychooncology 1997;6:290–301.
112.
Capuron L, Ravaud A, Gualde N, Bosmans E, Dantzer R, Maes M, Neveu PJ: Association between immune activation and early depressive symptoms in cancer patients treated with interleukin-2-based therapy. Psychoneuroendocrinology 2001;26:797–808.
113.
Corbett EL, Doherty JF, Behrens RH: Adverse events associated with mefloquine: Study in returned travelers confirms authors’ findings. Br Med J 1996;313:1552.
114.
Phillips MA, Kass RB: User acceptability patterns for mefloquine and doxyclycline malaria chemoprophylaxis. J Travel Med 1996;3:40–45.
115.
van Riemsdijk MM, van der Klauw MM, van Heest JA, Reedeker FR, Ligthelm RJ, Herings RM, Stricker BH: Neuro-psychiatric effects of antimalarials. Eur J Clin Pharmacol 1997;52:1–6.
116.
Boudreau E, Schuster B, Sanchez J, Novakowski W, Johnson R, Redmond D, Hanson R, Dausel L: Tolerability of prophylactic Lariam regimens. Trop Med Parasitol 1993;44:257–265.
117.
Schipper H, Clinch J, McMurray A, Levitt M: Measuring the quality of life of cancer patients: Functional living index. Ann NY Acad Sci 1995;761:365–368.
118.
Shariff S, Cumming CE, Lees A, Handman M, Cumming DC: Mood disorder in women with early breast cancer taking tamoxifen, an estradiol receptor antagonist. An expected or unexpected effect? Ann NY Acad Sci 1995;761:365–368.
119.
Breuer B, Anderson R: The relationship of tamoxifen with dementia, depression, and dependence in activities of daily living in elderly nursing home residents. Women Health 2000;31:71–85.
120.
Day R, Ganz PA, Costantino JP: Tamoxifen and depression: More evidence from the National Surgical Adjuvant Breast and Bowel Project’s Breast Cancer Prevention (P-1) Randomized Study. J Natl Cancer Inst 2001;93:1615–1623.
121.
Silverstone PH: Prevalence of psychiatric disorders in medical inpatients. J Neurol Neurosurg Psychiatry 1996;184:43–51.
122.
Fava GA, Mangelli L, Ruini C: Assessment of psychological distress in the setting of medical disease. Psychother Psychosom 2001;70:171–175.
123.
Horwitz RI, Singer BH, Makuch RW, Viscoli CM: Can treatment that is helpful on average be harmful to some patients? A study of the conflicting information needs of clinical inquiry and drug regulation. J Clin Epidemiol 1996;49:395–400.
124.
Otto MW, Nierenberg AA: Assay sensitivity, failed clinical trials, and the conduct of science. Psychother Psychosom 2002;71:241–243.
125.
Fava M, Evins AE, Dorer DJ, Schoenfeld DA: The problem of the placebo response in clinical trials for psychiatric disorders: culprits, possible remedies, and a novel study design approach. Psychother Psychosom 2003;72:115–127.
126.
Grandi S: The sequential parallel comparison model: A revolution in the design of clinical trials. Psychother Psychosom 2003;72:113–114.
127.
Sharpe L, Ryan B, Allard S, Sensky T: Testing for the integrity of blinding in clinical trials: how valid are forced choice paradigms? Psychother Psychosom 2003;72:128–131.
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