Maladies from medication?

“Your medication may be

meddling with your mood.”

I am a 44-year-old male, and I was diagnosed with hypertension last year. I began medication for the same, but recently I had been feeling extremely low and lethargic and had lost interest in the things I liked earlier. I began to feel irritable and snappy, miss meals, and lose sleep. Some days, I even felt like there was no purpose to my life. I decided to seek help from a psychiatrist, and the doctor didn’t give me any medication at first but instead screened me and said that my blood pressure medication may be causing me these issues. Can this be true?

“Proper medication is like a tuning fork for the body; it brings you back into balance.”

- Tracy Morgan

The field of medicine has evolved by leaps and bounds over the years. With healthcare innovations, our quality of life has improved drastically. According to the World Health Organisation, global life expectancy increased from 64.6 years in 1990 to 72.6 years in 2019.

While medication plays a significant role in the betterment of our health and in regulating certain medical conditions, it can also come with its own set of side effects. Some medications can cause psychiatric manifestations as part of their side effect profile. This can cause a dilemma as to whether to continue or not.

The feeling of depression is hard to live with, and people are constantly endeavouring to boost their emotional wellness with new treatments comprising the right antidepressants, meditation,

therapy or a combination of all of the above. But what some

might not realise is that their depression is being caused by another type of treatment: the medication they’re taking to address other conditions. The following medications are known to cause psychiatric manifestations in some people, if taken over a long period of time:

* Beta-blockers: Your blood pressure medicine increases the risk of depression.

What are these?

Medications like propranolol and metoprolol belonging to a group called beta-blockers are commonly used to treat conditions such as high blood pressure, heart failure, and arrhythmias. Even though it is overall safe, some people can experience side effects, including depression.

How do they lead to depression?

The exact underlying mechanism is unknown. Some propose interference with the balance of neurotransmitters in the brain, which can affect mood, e.g., norepinephrine. More recent research argues that due to the slowing down of the heart rate, there is an increased risk of fatigue, tiredness, nightmares, and insomnia, which can mimic depression.

Will everyone who takes the medication end up with depression?

No. It’s important to note that depression is a relatively rare side effect of beta blockers, and most people who take these medications do not experience any mood changes. If you are facing issues, always check with your prescribing doctor, as many other antihypertensives can be taken instead. Even this medication can be continued by adding an antidepressant.

* Sleeping medication: these can precipitate depressive features.

What are these?

Benzodiazepines, e.g., drugs like Alprazolam, Clonazepam, Lorazepam, etc., can lead to depression.

Insomnia is rampant all around the globe, and these medications are often resorted to and even abused to help aid sleep. If someone has a pre-existing history of depression, there can be a worsening of these thoughts when taking long-term benzodiazepines.

* GI medication: acidity medication

What are these?

Prolonged use of medications such as PPIs (proton pump inhibitors) including Pantoprazole, Lansoprazole, and Rabeprazole can cause depression.

How do they lead to depression?

The underlying mechanism is due to the disrupted gut-brain axis, which prevents the organisms from properly absorbing nutrients after the use of stomach drugs.

Prolonged use should be avoided.

* Allergy medication: Montelukast

What are these?

Chances are that if you have a history of allergies, you may go to a doctor who prescribes you a course of medication to help prevent a flare-up. Montelukast is a leukotriene receptor antagonist that is commonly used to treat asthma and allergies.

There is an increased risk of depression and other mood changes, particularly in children and adolescents. Montelukast has a black box warning related to the potential for neuropsychiatric events including agitation, aggression, depression, sleep disturbances, and suicidal thoughts or actions. While these are rare, they can be reported both in children and adults, and one should immediately report them to their doctor.

* Corticosteroids: cortisone and prednisone

What are these?

Also known as steroids, these medications are lifesaving drugs in certain cases and can also help in a wide range of inflammatory conditions, including arthritis, asthma, allergies, autoimmune diseases, and skin conditions such as eczema and psoriasis. They are provided for organ transplants and even during COVID treatment for complicated cases.

How can they lead to depression?

Lowering of the serotonin levels in the brain can cause depression, aggression, and other psychological conditions.

* HRT: hormone replacement therapy

Hormone replacement therapy (HRT): HRT is commonly used to treat menopausal symptoms and for transition, but some studies have suggested that it may increase the risk of depression.

* Interferon-alpha

What is this?

This medication is used to treat hepatitis B and C, as well as some forms of cancer. It has been associated with an increased risk of depression and other psychiatric side-effects.

* Tuberculosis medicines

Anti-tuberculosis medications may also play a role in psychiatric disease.

The various medications in the regimen, like isoniazid, alter serotonin uptake, and high doses of ethambutol have been associated with depression. TB drugs (such as cycloserine) lead to extreme mental health problems such as anxiety and depression.

What to do in case you are on these medications and diagnosed with depression?

Treatment for most of the above lies in either tapering and stopping the offending drug or adding an antidepressant, along with providing emotional support in the form of cognitive behavioural therapy.

Do not stop any medication on your own. Always check with your doctor. Seeing a psychiatrist can help bring clarity to your mental health condition.

Send your questions to help@dreradutta.com