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Use of prescription drugs with depression, suicidality as potential adverse effects common among U.S. adults

A new study investigated the prevalence of use of prescription medications that have depression or suicidality as potential adverse effects among U.S. adults. Data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative survey, were obtained from the five two-year cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014). For this analysis, only data from participants aged 18 years or older were examined (n = 26,192). NHANES measures of interest included depression (as measured by the Patient Health Questionnaire 9 [PHQ-9]) and prescription medication use data. During data collection, participants were asked to show interviewers all of the prescription medications they had used in the past month. These medications were then linked to a propriety drug database containing information on all prescription drugs. The software tool Microdex was used to identify medications with the potential for depression and suicidal symptoms as adverse effects. Participants also reported their sociodemographic characteristics and number of chronic health conditions. Prevalence estimates and standard errors were calculated using Taylor linearization methods; logistic regressions were performed to test for significance of trends. Multiple imputation with chained equations was used to handle missing data. Results indicated 37.2% (95% confidence interval [CI]: 36.0% – 38.3%) of the sample reported using at least one medication with the potential for depression as an adverse effect in the past month and 7.6% (CI:  7.1% – 8.2%) reported experiencing depression during the study period. In 2005-2006, 6.9% (CI: 6.2% – 7.6%) reported concurrent use of three or more such medications, compared to 9.5% (CI: 8.4% – 10.7%) in 2013-2014. Similarly, the rate of any use of medications with the potential for suicidal symptoms as an adverse effect increased from 17.3% (CI: 15.9% – 18.8%) in 2005-2006 to 23.5% (CI: 21.8% – 25.2%) in 2013 – 2014. Among participants who reported taking one medication with the potential for depression as an adverse effect, the prevalence of depression was 6.9%, compared to 15.3% among those taking three or more such medications concurrently and 4.7% among those not taking any of these medications. For suicidality, these rates were 8.3%, 17.8%, and 5.3%, respectively. The authors found no significant interaction between the use of medications that have depression as a potential adverse effect and the use of those that have suicidality as a potential adverse effect (p = 0.72). Excluding participants who took psychotropic medications, those who were concurrently using three or more medications with the potential of depression as an adverse effect were more likely to report concurrent depression (8.5% [CI: 5.0% – 12.0%]) compared with participants not using any of these medications (4.5% [CI: 4.0% – 5.0%]). Limitations of this study include its cross-sectional design and restriction to prescription medications alone.

Take away: This study documented that nearly 40% of U.S. adults reported using prescription medications with the potential for depression as an adverse side effect. Nearly 25% reported using prescription drugs with suicidality as a potential adverse effect.

Mazen Qato, D., Ozenberger, K. & Olfson, M. (2018). Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States. Journal of the American Medical Association [published online ahead of print June 12, 2018] doi: 10.1001/jama.2018.6741

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