Update on Drug-Induced Depression in the Elderly

https://doi.org/10.1016/j.amjopharm.2005.09.014Get rights and content

Background:

Depression is a common disorder in the elderly. Use of certain medications may be a potentially preventablecause of new-onset depression or worsening of established depression.

Objective:

This paper reviews recent publications evaluating medications commonly used in the elderly as potential causes of depressive symptoms.

Methods:

Relevant articles examining the association between medication use and symptoms of depression wereidentified through searches of MEDLINE (1996-March 2005) and International Pharmaceutical Abstracts (1996–March 2005) using the McSH heading depression and the subheading chemically induced. Included articles were limited to those that discussed medications commonly used in the elderly and that employed a rigorous study design.

Results:

A wide variety of medications have been implicated as potential causes of depressive symptoms in numerous reports, although many of these reports relied on data obtained from observational rather than experimental studies. The most extensively studied agents include anti hypertensives, lipid-lowering drugs, and selective estrogen-receptor modulators. The data on antihypertensive agents were contradictory; however, most studies found no association between use of the newer lipid-lowering drugs (statins) or selective estrogen-receptor modulators and the emergence of depressive symptoms. Corticosteroids, although not studied recently, generally have been associated with depressive symptoms in the older literature.

Conclusions:

The recent data evaluating whether medications can induce or worsen symptoms of depression arelargely contradictory. This reflects a relative lack of controlled studies of this association and the difficulties in determining whether depressive symptoms are caused by a particular medication or by other factors. Nonetheless, when new or worsening symptoms of depression occur, medications should be considered a potential cause and withdrawn as appropriate. Nonpharmacologic and/or pharmacologic treatment is indicated for those whose depressive symptoms do not resolve.

References (99)

  • RudischB. et al.

    Epidemiology of comorbid coronary artery disease and depression

    Biol Psychiatry

    (2003)
  • Cremona-BarbaroA.

    Propranolol and depression

    Lancet

    (1983)
  • SchleiferS.J. et al.

    Digitalis and beta-blocking agents: Effects on depression following myocardial infarction

    Am Heart J

    (1991)
  • GermainL. et al.

    Treatment of recurrent unipolar major depression with captopril

    Biol Psychiatry

    (1988)
  • Young-XuY. et al.

    Long-term statin use and psychological well-being

    J Am Coll Cardiol

    (2003)
  • PattenS.B. et al.

    Medication use and major depressive syndrome in a community population

    Compr Psychiatry

    (2001)
  • GiftA.G. et al.

    Depression, somatization and steroid use in chronic obstructive pulmonary disease

    Int J Nurs Stud.

    (1989)
  • ZweifelJ.E. et al.

    A meta-analysis of the effect of hormone replacement therapy upon depressed mood

    Psychoneuroendocrinology.

    (1997)
  • van DijkK.N. et al.

    Concomitant prescribing of benzodiazepines during antidepressant therapy in the elderly

    J Clin Epidemiol

    (2002)
  • YesavageJ.A. et al.

    Development and validation of a geriatric depression screening scale: A preliminary report

    J Psychiatr Res.

    (1982–1983)
  • AlexopoulosG.S. et al.

    Cornell Scale for Depression in Dementia

    Biol Psychiatry

    (1988)
  • AsnisG.M. et al.

    Interferon-induced depression: Strategies in treatment

    Prog Neuropsycbopharmacol Biol Psychiatry

    (2005)
  • MulsantB.H. et al.

    Epidemiology and diagnosis of depression in late life

    J Clin Psychiatry

    (1999)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • BlazerD.G.

    Depression in late life: Review and commentary

    J Gerontol A Biol Sci Med Sci

    (2003)
  • KaufmanD.W. et al.

    Recent patterns of medication use in the ambulatory adult population of the United States: The Slone survey

    JAMA

    (2002)
  • DoshiJ.A. et al.

    National estimates of medication use in nursing homes: Findings from the 1997 Medicare Current Beneficiary Survey and the 1996 Medical Expenditure Survey

    J Am Geriatr Soc

    (2005)
  • PattenS.B. et al.

    Drug-induced depression

    Psychother Psychosong

    (1997)
  • PattenS.B. et al.

    Drug-induced depression. Incidence, avoidance and management

    Drug Saf.

    (1994)
  • GanziniL. et al.

    Drug-induced depression in the aged. What can be done?

    Drugs Aging

    (1993)
  • KlysnerR.

    Drug-induced depression

    Pharmacol Toxicol

    (1992)
  • CliffordG.M. et al.

    Drug or symptom-induced depression in men treated with alpha 1-blockers for benign prostatic hyperplasia? A nested case control study

    Pharmacoepidemiol Drug Saf

    (2002)
  • DayR. et al.

    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 Lust

    (2001)
  • DayR. et al.

    Health-related quality of life and tamoxifen in breast cancer prevention: A report from the National Surgical Adjuvant Breast and Bowel Project P-1study

    J Clin Oncol

    (1999)
  • GasseC. et al.

    Risk of suicide among users of calcium channel blockers: Population based, nested case-control study

    BMJ

    (2000)
  • HaskellS.G. et al.

    The effect of raloxifene on cognitive function in postmenopausal women: A randomized clinical trial

    Conn Med

    (2004)
  • KoD.T. et al.

    Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction

    JAMA

    (2002)
  • LesterD.

    Serum cholesterol levels and suicide: A metaanalysis

    Suicide Life Threat Behav

    (2002)
  • LevinsonD.F. et al.

    Psychiatric adverse events during vigabatrin therapy

    Neurology

    (1999)
  • LouisW.J. et al.

    Use of computerized neuropsychological tests (CANTAB) to assess cognitive effects of antihypertensive drugs in the elderly. CambridgeNeuropsychological Test Automated Battery

    J Hypertens

    (1999)
  • MuldoonM.F. et al.

    Cholesterol reduction and non-illness mortality: Meta-analysis of randomised clinical trials

    BMJ

    (2001)
  • NystedtM. et al.

    Randomized trial of adjuvant tamoxifen and/or goserelin in premenopausal breast cancer-self-rated physiological effects and symptoms

    Acta Oncol

    (2000)
  • PattenS.B. et al.

    Cast control studies of cardiovascular medications as risk factors for clinically diagnosed depressive disorders in a hospitalized population

    Can J Psychiatry

    (1996)
  • PattenS.B. et al.

    H2 blocker exposure as a risk factor for depression

    Can J Psychiatry

    (1996)
  • StewartR.A. et al.

    Long-term assessment of psychological well-being in a randomized placebo-controlled trial of cholesterol reduction with pravastatin

    Arch Intern Med

    (2000)
  • WardleJ. et al.

    Randomised placebo controlled trial of effect on mood of lowering cholesterol concentration

    BMJ

    (1996)
  • WildingJ. et al.

    A randomized double-blind placebocontrolled study of the long-term efficacy and safety of topiramate in the treatment of obese subjects

    Int J Obes Relat Metab Disord

    (2004)
  • YaffeK. et al.

    Cognitive function in postmenopausal women treated with raloxifene

    N Engl J Med

    (2001)
  • YangC.C. et al.

    Lipid-lowering drugs and the risk of depression and suicidal behavior

    Arch Intern Med

    (2003)
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