If you think a drug you're taking might be causing your depression, you may be right. Certain medications prescribed for various medical conditions do cause such feelings as sadness, despair, and discouragement. And those are feelings that are often associated with depression. Other medicines prescribed for medical problems can trigger mania (excessive elation and energy) that's usually associated with bipolar disorder.
Medications that cause mania or depression appear to alter brain chemicals in some way. And even though the drugs may be necessary to treat the condition, the side effect is hardly acceptable. As an example, isotretinoin (Absorica, Amnesteem, Claravis, Myorisan, Zenatane), which is prescribed for the treatment of acne, has been found to also sometimes cause depression. So have oral contraceptives, high blood pressure drugs, and even statins that treat high cholesterol.
How Can I Know if a Drug May Be Causing Depression or Mania?
The best way to know if a drug could be affecting your mood in a negative way is to know which medicines commonly cause depression or mania. Then talk to your doctor to see if any of the medicines you are taking are likely causing or contributing to mood symptoms, and if so, discuss whether a different medication may be a better choice. Your doctor should let you know up front which drugs might cause feelings of depression or mania and should evaluate whether mood symptoms are or are not likely related to medicines.
Drugs That Might Cause Mania (Excessive Elation)
The following drugs could cause symptoms of mania. Even though the risk for some of these drugs might not be high, you should discuss the risk with your doctor if you take them:
- Corticosteroids. This group of drugs decreases inflammation (swelling) and reduces the activity of the immune system (cells that fight infection). Examples include Azmacort, Flovent, hydrocortisone, prednisone, and triamcinolone.
- Cyclosporine. This drug is used to suppress the immune system to prevent the rejection of transplanted organs.
- Carbidopa/levodopa (Duopa, Rytary, Sinemet). These medicines treat Parkinson's disease.
- Baclofen intrathecal (Lioresal). This is a muscle relaxant and antispastic agent. It's often used to treat multiple sclerosis and spinal cord injuries.
- All antidepressants, including MAOIs (monoamine oxidase inhibitors, such as phenelzine (Nardil) or tranylcypromine (Parnate); SSRIs (selective serotonin reuptake inhibitors such as escitalopram (Lexapro), fluoxetine (Prozac), and paroxetine (Paxil); SNRIs (serotonin/norepinephrine reuptake inhibitors, such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), venlafaxine (Effexor XR); and tricyclic antidepressants (such as nortriptyline (Pamelor).
- Methylphenidate (Ritalin) or amphetamine. These are stimulant drugs used to treat attention deficit hyperactivity disorder (ADHD).
- Levothyroxine (Levoxyl, Synthroid, Tirosint, Unithroid). This drug is commonly prescribed as a thyroid hormone replacement.
- Certain antibiotics, such as ciprofloxacin (Cipro) and gentamicin
- Antimalarial drugs, such as chloroquine and mefloquine
- Antineoplastic drugs such as 5-fluorouracil and ifosfamide
Drugs That May Cause Depression
The following drugs have been reported to cause depression in some patients. Elderly people are particularly at risk.
- Isotretinoin (Absorica , Amnesteem , Claravis, Sotret): This drug treats severe acne.
- Alcohol
- Anticonvulsants: Anticonvulsants are used to control epileptic seizures, examples include ethosuximide (Zarontin) and methsuximide (Celontin).
- Barbiturates: These are a group of central nervous system depressants that slow down brain function. These medicines have been used to treat anxiety and to prevent epileptic seizures. They are commonly abused; examples are phenobarbital and secobarbital.
- Benzodiazepines: This group of central nervous system depressants is often used to treat anxiety and insomnia and to relax muscles; examples include alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), and triazolam (Halcion).
- Beta-adrenergic blockers -- Also known as beta-blockers, these medicines are used in the treatment of various heart problems, including high blood pressure, heart failure, chest pain caused by angina, and certain abnormal heart rhythms. They may also be used to treat migraine headaches; examples include atenolol (Tenormin), carvedilol (Coreg), and metoprolol (Lopressor).
- Calcium-channel blockers: This group of medicines slows the heart rate and relaxes blood vessels. Calcium channel blockers are used to treat high blood pressure, chest pain, congestive heart failure, and certain abnormal heart rhythms, examples include diltiazem (Cardizem, Tiazac), nifedipine (Procardia), and verapamil (Calan).
- Interferon alfa: This drug is used to treat certain cancers as well as hepatitis B and C.
- NuvaRing with ehinyl estradiol/etonogestrel: This is a medicine used for birth control.
- Opioids: This group of narcotics is used to relieve moderate to severe pain. These drugs have a high potential for abuse and addiction; examples include spirin/oxycodone (Percodan), codeine, meperidine (Demerol), morphine, and oxycodone (OxyContin).
- Statins: These medicines are used to lower cholesterol, protect against damage from coronary artery disease, and prevent heart attacks; examples include atorvastatin (Lipitor), fluvastatin (Lescol), pravastatin (Pravachol), and simvastatin (Zocor).
- Varenicline (Chantix): A medication prescribed for smoking cessation.
- Acyclovir (Zovirax): Doctors prescribe this drug to treat shingles and herpes.
What Should I Do If I Think My Medicine Causes Depression or Mania?
Be sure to discuss with your doctor any concerns you may have about how a medicine might be affecting your mood. When a medicine does produce symptoms of mania or depression, your doctor may recommend discontinuing the drug or reducing the dosage (if possible). If this is not possible, your doctor may treat the manic or depressive symptoms with other drugs.
Should I Stop Taking a Drug If It Causes Depression or Mania?
If you do experience depression or mania while taking one of these medications or any other, call your doctor immediately. Do not stop taking the medicine unless directed to do so by your doctor. In all cases, the risk of side effects must be balanced against the risk and discomfort of not treating the disease.