Use of Non-Psychiatric Medications With Potential Depressive Symptom Side Effects and Level of Depressive Symptoms in Major Depressive Disorder

Ramin Mojtabai, MD, PhD, MPH^a,b ; Masoumeh Amin-Esmaeili, MD, MPH^a ; Stanislav Spivak, MD^b ; Mark Olfson, MD, MPH^c

J Clin Psychiatry 2023;84(4):22m14705

ABSTRACT

Objective: To determine whether use of medications with potential depressive symptom side effects is associated with a higher level of depressive symptoms in adults with antidepressant-treated major depressive disorder (MDD).

Methods: The study was based on the 2013–2014, 2015–2016, and 2017–2018 National Health and Nutrition Examination Survey (NHANES)—a nationally representative cross-sectional survey of the US general population. In 885 adult participants from these NHANES cycles who reported receiving antidepressants for treatment of International Classification of Diseases, Tenth Revision, Clinical Modification MDD, the association between the number of medications with potential depressive symptom side effects and the level of depressive symptoms was assessed.

Results: A majority (66.7%, n = 618) of the participants with antidepressant-treated MDD used at least 1 non-psychiatric medication with potential depressive symptom side effects, and 37.3% (n = 370) used more than 1 such medication. The number of medications with depressive symptom side effects was significantly associated with lower odds of no to minimal depressive symptoms, defined as a Patient Health Questionnaire-9 (PHQ-9) score < 5 (adjusted odds ratio [AOR] = 0.75, 95% confidence interval [CI] = 0.64–0.87, P < .001), and higher odds of moderate to severe symptoms, defined as a PHQ-9 score ≥ 10 (AOR = 1.14, 95% CI = 1.004–1.29, P = .044). No such associations were found for medications without potential depressive symptom side effects.

Conclusions: Individuals treated for MDD frequently use non-psychiatric medications for comorbid medical conditions that are associated with an increased risk of depressive symptoms. In evaluating the response to antidepressant medication treatment, side effects of concomitantly used medications should be considered.

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