Drug-induced depression

Background: Certain drugs may contribute to the etiology of depressive symptoms and depressive disorders. The objective of this review is to critically appraise the literature concerned with these potential etiological associations. Method: The review was based on papers uncovered in electronic literature searches using Medline, Psychlit and Psychological Abstracts. Statistical power calculations were used to assist in the interpretation of negative results. Results: A large number of publications were uncovered, but most of these were case reports. There were relatively few empirical studies. Corticosteroids, certain calcium channel blockers and digoxin have been associated with depression by replicated, well conducted studies. Psychostimulant withdrawal is also associated with prominent depressive symptoms. Preliminary evidence suggests that antihyperlipidemic agents, angiotensin converting enzyme inhibitors, sedative hypnotics, psychostimulants and certain hormonal agents may also cause depression. Despite an extensive literature, the potential association between P-blockers and depressive symptoms remains controversial. There is no substantial evidence that I-dopa or histamine-2-receptor blockers cause depression and the literature is relatively conclusive in determining that thiazide diuretics are not associated with depressive symptoms. Conclusions: A small, but growing, literature confirms that certain drug exposures can contribute to the biopsychosocial etiology of depressive symptoms and disorders. Current beliefs and diagnostic conventions classify drug-induced depression into a distinct category (Substance-Induced Mood Disorder): but this approach is not specifically supported by the existing literature.