A recent Journal of the American Medical Association (JAMA) study found that many common medications that Americans take regularly, such as drugs for acid reflux or high blood pressure, have the potential to cause depression as a side effect.
The study, published in JAMA‘s June 12 issue, analyzed federal health survey data collected from U.S. adults between 2005 and 2014. Of the more than 26,000 participants, 7.6 percent who were regularly taking one medication reported having depression — and this doubled in those who were taking three or more medications.
“The estimated prevalence of depression was 15 percent for those reporting use of three or more medications with depression as an adverse effect, vs 4.7 percent for those not using such medications,” wrote the article’s co-authors.
The study also found that the number of Americans who regularly take medications that carry depression as a side effect has increased from 35 percent to 38.4 percent between 2005 and 2014. The percentage of people taking three or more these medications concurrently increased from 6.9 to 9.5 percent over the same timeframe.
American Counseling Association member Dixie Meyer says these findings only affirm the importance for counselors to familiarize themselves with medical diagnoses and commonly prescribed medicines. Also, counselors should routinely screen for depression in clients who take medications with depressive side effects, as well as those in at-risk groups, such as minorities, clients with low socio-economic status or who identify as LGBTQ.
As the evidence for the intertwined nature of the medical and mental health fields continues to accumulate, it becomes increasingly important for counselors to bring themselves up to speed on medical research that may inform clinical practice, says Meyer, an associate professor in the medical family therapy program in the department of family and community medicine at the St. Louis University School of Medicine. This can happen both through individual professional development and a profession-wide focus.
“We know that for professions to succeed, there needs to be a continual adaption. For the counseling field, counselor training programs need to include not only counseling but medical research evaluation,” Meyer says. “Counselors need to be trained in understanding the relationship between physical and mental health disorders. For example, trauma increases the likelihood for chronic health conditions.”
Meyer is also the director of the Relationships and Brain Science Research Laboratory at the St. Louis University School of Medicine. She frequently gives presentations to counselors on the importance of understanding their clients’ medications, including at ACA’s 2016 conference in Montreal. She recommends that all counselors have a copy of the Physicians’ Desk Reference on hand so that they can quickly look up any medication. Counselors can also refer to resources like Medscape.com for updates on the latest medical research that may inform clinical practice.
“Because this [JAMA] research is not a clinical trial or a prospective study that can inform the reader of temporal implications, we should interpret the results with caution as they are correlational in nature,” says Meyer. “It is not uncommon for physicians to prescribe, at the onset of treatment or later concurrently with treatment, a medication intended to manage side effects. While the sample with the 15 percent increased risk were taking three or more medications with the depression side effect, we can still expect the majority of individuals using these medications will not experience an increase in depression. Thus, any preventative care could be needless without symptoms present.”
When it comes to counselors, clients and medication, Meyer suggests the following:
- Intake forms should include use of both prescription and over-the-counter medications. The form should specify that he or she should include medications taken periodically or on an as-needed basis.
- Counselors should implement regular, monthly checks to assess if medication usage has changed.
- In addition to counselors systematically assessing how clients perceive the effectiveness of their psychotropic medication and side effect evaluation, the medication management component of counseling should include an assessment of those medications associated with depression risk, like anti-hypertensives, hormonal contraceptives and other hormone replacement therapy and proton pump inhibitors (commonly used to treat acid reflux).
- Clients being treated for depression, those in at-risk groups (LGBTQ, racial minorities, women, low-income) and those taking medications with depressive side effects need to be routinely screened for depression. A monthly screen for depression using widely available tools like the PhQ-2 or PHQ-9 can easily be incorporated into clinical practice without being too cumbersome for clients.
- Counselors need to monitor both the mood and somatic symptoms of depression in high-risk groups. Many of the symptoms of depression are somatic; thus, clients may be experiencing depressive symptoms that go unnoticed because they are unrelated to mood changes.
- Counselors need to be well-versed in who is at risk for depression. The [JAMA] research reported that the medications with potential depressive side effects were more likely to be given to those individuals already at an increased risk for depression (e.g., female, widowed, older populations and those with more chronic health conditions). Not only does this make it difficult to determine if the research is uncovering depression prevalence already present or if vulnerable populations are being placed in a position that increases their depression risk. Thus, counselors need to understand what the research tells us about who is at risk for depression — and counselors need to identify if these individuals are also taking medications with this potential side effect.
- Counselors need to encourage self-monitoring of mood symptoms and discuss with clients taking medications with depressive side effects how to intentionally monitor their mood at home. For example, smart phone apps designed to track mood are widely available.
Find out more
Read the full JAMA article: jamanetwork.com/journals/jama/article-abstract/2684607
From the Counseling Today archives:
“Healthy conversations to have” (on discussing psychiatric medication usage with clients)
Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at email@example.com
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.