Tuesday, January 5, 2010

Depression May Be a Side Effect of Other Medications You are Taking

When someone is feeling depressed or blue for a prolonged period, they often feel that they are carrying around an invisible, deeply painful and condition. Many persons with depression are also being treated for other medical conditions, and may have contributing factors that perpetuate the feeling of internal pain. A careful history as well as an honest review of over the counter and prescription medications as well as lifestyle issues such as social stress, work, sleep, diet and alcohol or other substance use needs to be factored into planning a strategy to reduce pain.

You and your doctor need to also evaluate your risk of bipolar disorder (Manic Depression), panic disorder, and suicidal risk early in the conversation, all of which require a slightly or substantially different approach.

It is important that you recognize that depression can be mild moderate or severe. If severe, it can be a serious life threatening condition. Treatment often requires a step wise process that often takes at least a few months to yield substantial improvement, so you and your health care provider need to maintain a longer term horizon of expectations. Your health care provider should have several strategies that can at least take away some of the immediate pain while you are waiting for longer term improvement.

Several medication classes can cause an unexpected or idiosyncratic reaction to a given individual and act as an anchor to improvement or actually lead to your current depressive episode. Keep in mind that even if you are taking a medication listed below and have concern about its side effects, any change or withdrawal of medication should occur only after you and your health care provider have had discussions about the relative risk : benefits of any such changes.

Common medications that are more commonly associated with unexpected psychic pain include;

1) Blood pressure and heart disease medications;
Central alpha 2 receptor agonist class- Reserpine, Methyldopa & Guanfacine (Aldomet & Tenex- older blood pressure lowering medications), Clonidine (Catapress- another older blood pressure medication also used for drug and alcohol withdrawal), as well as potentially Tizanidine (Zanaflex a muscle relaxant often used in the treatment of chronic pain),
Beta blockers (many brands- used to lower blood pressure and reduce heart rate and to treat coronary heart disease as well as congestive heart failure).
Digoxin (Lanoxin- used for heart rate slowing as well as congestive heart failure)
Diuretics (many brands- used to lower blood pressure but can especially lead to low mood if associated with lower blood and tissue levels of potassium and sodium salts)

2) Sedative-hypnotic agents;
Barbituate class (many different medications used for control of seizure disorders, headache treatment- Esgic, Fioricet etc, as well as for sleep. Common preparations have Butalbitol, Meprobamate, chloral hydrate as well as Phenobarbital.
Benzodiazepine class (many different medications used for helping with sleep, and to reduce anxiety, panic and stress. They are also commonly used and are often appropriate in conjunction with antidepressant medications both short term and long term to reduce side effects and control anxiety. Common names include Lorazepam/Ativan, Alprazolam/Xanax, Clonezapam/Klonepin.
Alcohol especially if used medicinally on a regular basis or in excess by the patient to aid with control of anxiety, pain and insomnia.
Other sleep aids, OTC and Rx may play a role here as well and need to be discussed with your doctor.

3) Anti-inflammatory agents and opiates;
Opiates/Narcotic agents are commonly used to treat acute and chronic pain syndromes and are obtained both by prescription and sometimes by illicit means.
Anti-inflammatory steroids used to treat acute and chronic inflammation, pain, allergic and autoimmune conditions. Common names are; Dexamethasone/Decadron, Prednisone, Medrol/ Medrol dose pack. Use and withdrawal can both be associated with depressed mood. Keep in mind if you are taking any steroid for more than 2 weeks be certain to discuss a slow weaning process with your health care provider to prevent a major side effect from too rapid a withdrawal from anti-inflammatory steroid use.

4) Hormones;
Oral contraceptives
Estrogen and estrogen withdrawal
Anabolic steroids used for muscle bulking and most commonly obtained through illicit means

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