A study published June 12, 2018 from the University of Illinois at Chicago suggests that more than one-third (37.2%) of U.S. adults may be using prescription drugs that have the potential to cause depression or increase the risk of suicide.
[JAMA. 2018;319(22);2289-2298. doi:10.1001/jama.2018.6741]
Information about more than 26,000 adults from 2005 to 2014 was analyzed, along with more than 200 commonly prescribed drugs. However, many of these drugs are also available over the counter, so these results may underestimate the true prevalence of drugs having side effects of depression.
In other words, the use of prescription drugs, not just psychiatric drugs, that have depression or suicide as a potential adverse reaction is fairly common, and the more drugs one takes (called polypharmacy), the greater the likelihood of depression occurring as a side effect. “The likelihood of concurrent depression was most pronounced among adults concurrently using 3 or more medications with depression as a potential adverse effect, including among adults treated with antidepressants.”
Approximately 15% of adults who used three or more of these drugs concurrently experienced symptoms of depression or suicidal thoughts, compared with just 5% for those not using any of these drugs. Roughly 7.6% of adults using just one of these drugs reported a side effect of depression or suicidal thoughts during the study period, and 9% for those using two of these drugs. These results were the same whether the drugs were psychotropic or not. Depression was determined by asking nine questions related to the symptoms defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
“Commonly used depression screening instruments, however, do not incorporate evaluations of prescribed medications that have depression as a potential adverse effect.” In other words, so-called depression screening tests can register false positives when the person is taking one or more of roughly 200 prescription drugs.
We thought we should dig a little deeper into this phenomenon.
First, understand that there is no depression “disease”. A person can certainly have symptoms of feeling depressed, but this is not a medical condition in itself. An example of a medical condition with a symptom of depression would be a vitamin B1 (thiamine) deficiency. You don’t fix it with an antidepressant; you fix it with vitamin B1. There are hundreds of medical conditions that may have mental symptoms, just as there are hundreds of drugs that can cause or worsen these symptoms. Finding the actual causes with appropriate clinical tests and then fixing what is found is the correct way to proceed.
This leads to a topic known as CYP450, which stands for Cytochrome P450 enzymes. Cytochrome means “cellular pigment” and is a protein found in blood cells. Scientists understand these enzymes to be responsible for metabolizing almost half of all drugs currently on the market, including psychiatric drugs.
These are the major enzymes involved in drug metabolism, which is the breakdown of drugs in the liver or other organs so that they can be eliminated from the body once they have performed their function.
If these drugs are not metabolized and eliminated once they have done their work, they build up and become concentrated in the body, and then act as toxins. The possibility of harmful side effects, or adverse reactions, increases as the toxic concentration increases. The ballpark estimate is that each year 2.2 million Americans are hospitalized for adverse reactions and over 100,000 die from them.
Some people are deficient in CYP450 or have diminished capacity to metabolize these drugs, which may be a genetic or other issue. Individuals with no or poorly performing CYP450 enzymes are much more likely to suffer the side effects of prescription drugs, particularly psychiatric drugs known to have side effects of depression, violence and suicide.
These metabolic processes are immature at birth and up to three years old, and this may result in an increased risk for drug toxicity in infants and young children. Furthermore, certain drugs or certain excipients in vaccines may inhibit activation of CYP450 enzymes, again resulting in an increased risk for the accumulation of non-metabolized drugs and the resultant increase in adverse side effects such as depression, violence and suicide.
The side effects caused by a CYP450 deficiency and its subsequent failure to metabolize any one of hundreds of drugs can then be misdiagnosed as a mental illness, the patient then being prescribed more psychiatric drugs in a mistaken attempt to treat those side effects, further complicating the problems.
It is estimated that 10% of Caucasians and 7% of African Americans are Cytochrome P450 deficient.
The psychiatric and pharmaceutical industries have been aware of this phenomenon for some time, yet they have continued to push psychiatric drugs at an ever increasing rate, and the dramatic increase in symptoms of depression, suicide, and school violence is a direct result.
No one should be prescribed these types of drugs without adequate testing for a CYP450 deficiency, in order to determine their risk potential for adverse reactions. The test is not “standard of care” so one has to ask for it; but beware, they will still recommend an alternative drug if the original one cannot be easily metabolized. Better yet, stop prescribing all psychiatric drugs and find out with proper medical, clinical tests what the real problems are and treat those. Full informed consent is always indicated.
Any psychiatrist or pharmaceutical company that has knowingly withheld evidence about the relationship between CYP450 enzymes and drug side effects should be subject to both prosecution and litigation.
Medical students should be educated about these relationships.
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