Understanding Medications That Cause Depression or Impact Mood

Overview of Drug-Induced Mental Health Impacts

In 2018, a JAMA study found that more than one-third of adults in the United States take a medication that can cause depression and mood symptoms as side effects. Yet, many people who take these commonly prescribed drugs are unaware that they can cause depressive symptoms.

The truth is that certain medications, which are U.S. Food and Drug Administration (FDA) approved and widely prescribed to treat a variety of medical conditions, can affect the central nervous system and alter brain chemicals, thereby causing depression.

Importance of Recognizing Medication Side Effects On Mood

Many medications that cause adverse effects like depression are not prescribed for mental health conditions. Sometimes, doctors do not warn patients of the risk of depressive symptoms. As a result, many patients are unaware that depression is one of the side effects of their medication.

Drug-induced depression can lead to feelings of sadness, despair, and suicidal ideation (thoughts of self-harm and increased risk of suicide).

While treating a medical condition with a particular medication might be necessary, developing major depression as a side effect is highly undesirable and must be addressed immediately.

It is not always possible to establish with certainty that a specific medication is the cause of your depressive symptoms. However, knowing which medications can cause a potential adverse effect like depression is important. This way, you can talk to your doctor and discuss alternative options if a particular medicine you are taking is associated with depression.

Importance of Healthcare Provider Consultation

As mentioned, some medications are known to cause adverse effects like depression, but it is impossible to predict if this side effect will occur. Each individual’s reaction to a medication varies. Also, drug interactions with other medications can cause unexpected side effects.

That’s why it’s important to tell your doctor about all the medications you are currently taking, including prescription drugs, over-the-counter medicines, herbal remedies, and dietary supplements.

You should also talk to your doctor about any potential medication side effects before starting a new drug.

In the following paragraphs, we will describe some of the common medications that may cause depression. This is not a comprehensive list. If you have treatment-resistant depression or believe you are experiencing depression as a result of medication, please do not hesitate to address your concern with your doctor or pharmacist.

Common Medications That Can Cause Depressive Symptoms

Common medications that are depressogenic (associated with depression) include:

Beta-blockers used to treat high blood pressure, heart problems, and other medical conditions
Corticosteroids used to treat inflammatory conditions
Benzodiazepines used to treat anxiety
Medications used to treat Parkinson’s disease
Hormonal medications
Stimulants prescribed for attention-deficit/ hyperactivity disorder (ADHD)
Proton pump inhibitors used to treat gastroesophageal reflux disease (GERD)
Cholesterol-lowering medications
Antiepileptic drugs prescribed for seizure disorders
Anticholinergic drugs
Opioid pain medications
Allergy medications
Thyroid medications
Certain antibiotics

Cardiovascular Medications

Beta Blockers

Beta-blockers (β-blockers) are a class of drugs that are commonly prescribed to treat high blood pressure. Besides high blood pressure, beta-blockers may be prescribed for the treatment of angina (chest pain), arrhythmias (irregular heartbeat), migraines, tremors, and glaucoma.

Examples include atenolol (Tenormin), metoprolol, carvedilol (Coreg), and propranolol (Inderal).

Along with fatigue and sexual dysfunction, depression is one of the common side effects of beta-blockers. The mechanism behind it remains unknown. If beta blockers cause depression, your healthcare provider can prescribe other types of medications to treat high blood pressure, such as calcium channel blockers.

Statins and Other Cholesterol-Lowering Medications

Statins such as atorvastatin (Lipitor), simvastatin (Zocor), fluvastatin (Lescol), rosuvastatin (Crestor), and pravastatin (Lipostat) are commonly prescribed to lower cholesterol levels. Other lipid-lowering drugs include colesevelam, fibrates, nicotinic acid, and ezetimibe.

Research suggests these drugs may cause depressive symptoms by lowering cholesterol levels in the brain.

Psychiatric Medications

Benzodiazepines

Benzodiazepines are sedative-hypnotics or tranquilizers. They are used to treat anxiety and insomnia. They also have a muscle-relaxing effect.

Examples include alprazolam (Xanax) and diazepam (Valium).

Benzodiazepines suppress activity in the central nervous system and can produce a hangover effect if they build up to toxic levels. This can manifest as depressive symptoms. The risk of this side effect is higher in older individuals because they have a slower rate of drug clearance from the body.

Neurologic Medications

Medications Used to Treat Parkinson's Disease

Parkinson’s patients have low levels of dopamine, a neurotransmitter in the brain. The drugs used to treat Parkinson’s adjust dopamine levels in the central nervous system by directly or indirectly increasing the level of dopamine in the brain.

Examples include levodopa and carbidopa (brand names Sinemet and Stalevo). Other Parkinson’s drugs like ropinirole (Requip) and pramipexole (Mirapex) affect dopamine receptors in the central nervous system.

Dopamine is one of the three main neurotransmitters (along with norepinephrine and serotonin) associated with depression. Researchers believe that prolonged exposure to high levels of dopamine is associated with depression. Therefore, Parkinson’s Disease medication can cause depression as a long-term side effect.

Stimulants

Prescription stimulants are a group of drugs used to treat ADHD (attention-deficit/ hyperactivity disorder) and excessive daytime sleepiness due to conditions such as narcolepsy, hypersomnia, or sleep apnea.

Examples include modafinil (Provigil), amphetamine/dextroamphetamine (Adderall), and methylphenidate (Ritalin).

It is believed that these drugs can cause symptoms of depression due to prolonged exposure to elevated levels of dopamine in the central nervous system.

Anticonvulsants

Anticonvulsants or antiepileptics are used in the treatment of epilepsy (seizures) as well as other medical conditions such as neuropathic pain, mood disorders, mania, and bipolar disorder.

Examples include carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and pregabalin (Lyrica).

It is believed anticonvulsants might cause drug-induced depressive symptoms by altering the levels of mood-regulating neurotransmitters (natural chemicals) in the brain.

If you develop new-onset depression after starting an anti-seizure drug, talk to your doctor about alternative treatment options.

Anti-Inflammatory Medications

Corticosteroids

Another group of medications that may cause depression is corticosteroids. These drugs are commonly prescribed to treat inflammation in people with conditions such as rheumatoid arthritis, gout, lupus, and Sjogren’s syndrome.

Examples include prednisolone, methylprednisolone, cortisone, hydrocortisone, and triamcinolone.

Scientists believe corticosteroids can cause depression and mood symptoms by lowering levels of serotonin, a chemical in the brain that is involved in mood regulation.

Gastrointestinal Medications

Proton Pump Inhibitors and H2 Blockers

Proton pump inhibitors and H2 blockers are prescribed to suppress excess gastric acid production in people with gastroesophageal reflux disease (GERD).

Examples include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix), famotidine (Pepcid AC), ranitidine (Zantac), and cimetidine (Tagamet).

Why these drugs might lead to depression is unclear, but scientists believe it could be that changes in the stomach pH affect the central nervous system.

Anticholinergic Drugs

Anticholinergics are a group of drugs that block the effects of a chemical called acetylcholine, which is a neurotransmitter that causes muscle contraction. They are used to treat stomach cramps and other gastrointestinal disorders and to slow the contraction of the intestines. For example, dicyclomine (Bentyl), which is prescribed for irritable bowel syndrome (IBS).

Anticholinergics are also used to treat a variety of other medical conditions, including overactive bladder, asthma, motion sickness, and Parkinson’s disease.

These drugs are central nervous system depressants. They can cause depression and mood symptoms as side effects, especially in older patients.

Hormonal Medications

Oral Contraceptives and Hormone Replacement Therapy

Some women’s health medications, such as birth control pills and estrogen replacement therapy, are used to treat menopausal symptoms. They contain hormones and manipulate hormone levels in the body. This can affect the central nervous system and lead to depression.

If new-onset depression occurs after starting hormonal therapy, talk to your doctor about using other prescription or over-the-counter medications to manage your symptoms. Hormone-altering drugs that contain progestin-only are believed to be less likely to cause depression compared to combined hormonal therapy with estrogen and progesterone.

Gonadotropin Releasing Hormone (GnRH) Agonists

Gonadotropin-releasing hormone (GnRH) agonists are a group of hormonal drugs that prevent the ovaries and testes from releasing hormones. They are often used to treat conditions such as prostate cancer, endometriosis, uterine fibroids, and precocious puberty.

Examples include leuprolide (Lupron), goserelin (Zoladex), histrelin (Supprelin, Vantas), triptorelin (Trelstar), degarelix (Firmagon), and relugolix (Orgovyk).

Double-blind placebo-controlled studies have found that women who take GnRH agonists for endometriosis have an increased incidence of depressive mood symptoms. Scientists believe this occurs due to a decline in estrogen levels.

Other Drugs That Can Have Psychiatric Side Effects

Several other medications have been linked to mental health and can cause symptoms of depression as side effects. These include:

Acne medications (isotretinoin)
Prescription opioid pain relievers (OxyContin, Vicodin)
Allergy medications (cetirizine, montelukast)
Thyroid medications (levothyroxine)
Certain antibiotics (gentamicin, ciprofloxacin)
Antimalarial drugs (mefloquine)
HIV medicines (efavirenz)
Chemotherapy drugs
Immunologic agents such as interferon-alpha

Recognizing Depression Symptoms Related To Medications

Signs of Medication-Induced Depression

Medication-induced depression can cause the following signs and symptoms:

Persistent changes in mood
Loss of interest in activities or hobbies
Feelings of sadness, hopelessness, or worthlessness
Changes in sleep patterns (insomnia or oversleeping)
Low energy and fatigue
Changes in appetite
Difficulty concentrating
Thoughts of death or suicide

How To Tell If A Drug Is Causing Depression or Mood Changes

If you start treatment with a new medication and start noticing depressive symptoms soon thereafter, you can suspect a link. It might help to write down a list of your symptoms, when they started, and what makes them worse. This can help your prescribing doctor figure out if a specific medication could be causing depression as a side effect.

Managing Medication-Induced Mood Changes

Steps To Take If Medications Cause Depression or Mood Swings

Call your doctor if you suspect a medication may be causing depression. Do not stop taking the medicine or change the dose or dosing frequency of a prescribed medicine without consulting your healthcare provider.

When To Consult a Healthcare Provider

Consult a healthcare provider if you have symptoms of major depressive disorder (see above). It is especially important to seek professional medical care if your depression symptoms are severe enough to affect your daily life. For example, if you:

Find it difficult to complete work and home responsibilities due to low mood.
Have physical symptoms such as fatigue or sleep problems.
Have mental symptoms such as irritability, anger, and frustration that are affecting your relationships.

Call 911 and seek emergency medical help if you have thoughts of self-harm (suicidal ideation).

Medication Adjustments or Alternatives

If a medication is causing depression, your doctor may change you from a high dose to a lower dose or switch you to a different drug to treat your condition. If you have to continue taking the culprit medicine to treat a health condition, your healthcare provider may prescribe an antidepressant to treat your depressive symptoms.

It is worth noting that medications that may cause depression will not necessarily cause depression in everyone. Each person’s response to a medicine differs. Sometimes, a medication may not cause depression right away. Therefore, if you are experiencing symptoms of major depression, it is best to seek medical advice to identify the cause.

It is also worth noting that the risk of drug-induced depression as a side effect increases if you are taking more than one drug that can cause depression. In other words, people who are on two or more medications that can cause depression as a side effect have a higher risk of developing drug-induced depression. Severe depression should be diagnosed and treated because it can lead to self-harm (suicidal thoughts and actions).

Risks of Stopping Medications Due To Side Effects

If you suspect a medicine is causing depression symptoms, call your doctor for medical advice.

Never stop treatment with a prescribed medication without consulting your healthcare provider. Doing so can put you at risk of serious health complications. For example, stopping a medication used to treat angina (chest pain) or high blood pressure can increase your risk of cardiovascular events like a heart attack.

Also, stopping certain medications suddenly can result in serious medical complications. Your doctor can tell you how to lower the dose gradually and stop treatment over a period of days to weeks.

Common Concerns About Depression And Medications

What Are Some Depressed Mood Medications?

Commonly prescribed depressed mood medications include antidepressants like selective serotonin reuptake inhibitors (SSRIs) (for example, Zoloft, Prozac) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (for example, Effexor, Cymbalta). These drugs are used to treat major depressive disorder and other mental health conditions.

Can Medication Change Mood?

Yes, certain medications can change mood and cause depressive symptoms by affecting brain chemicals.

Can Depression Medication Cause Mood Swings?

Depression medication (antidepressants) can occasionally cause mood swings. For example, if someone with undiagnosed bipolar disorder is prescribed an antidepressant during a depressive illness, it can trigger hypomania or mania. Bipolar disorder is a mental illness characterized by severe mood swings, alternating between depression and abnormal excitement (mania). Healthcare providers ask about a personal or family history of bipolar illness before prescribing antidepressants.

What Medications Cause Anger And Irritability?

Many of the same medications that can cause depression can also cause anger and irritability as side effects, including corticosteroids, ADHD medications, cholesterol-lowering drugs, birth control pills, and proton pump inhibitors.

Resources and Support For Managing Depression

Self-Care Strategies

Eat a healthy, balanced diet. A nutritious diet supports overall physical and mental health.
Get regular exercise. Exercise releases mood-boosting chemicals in the brain.
Stay in touch with loved ones. Withdrawal from social life can lead to worsening depression symptoms.
Avoid drinking alcohol or using drugs. Substance abuse can temporarily relieve depression but can lead to serious mental health problems such as addiction.

Accessing Expert Help and Treatment Options

If self-care does not relieve depression, talk to your primary care provider. They can refer you to a mental health professional for proper diagnosis and treatment of depression. This may include licensed therapists, counselors, psychologists, and psychiatrists. These medical professionals can prescribe medications to treat your symptoms as well as other evidence-based treatments for depression, such as cognitive behavioral therapy (CBT) and other forms of talk therapy.

Further Reading and Research on Drug-Induced Depression

American Society of Health System Pharmacists (ASHP)
American Association of Retired Persons (AARP)

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