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Depression and Adverse Drug Reactions

Depression and Adverse Drug Reactions In their recent article, Davies et al1 reported that among subjects referring to a hypertension clinic, depression was associated with an increased reduction or cessation of antihypertensive drugs owing to an adverse effect that reflected subjective symptoms. This finding would suggest that depressed subjects can amplify somatic symptoms, leading to a higher report rate of adverse drug events. However, in a previous study conducted in a large population of hospitalized older adults, we showed that depressive symptoms were similarly associated with adverse drug reactions represented by subjective symptoms (ie, headache, abdominal pain, and nausea) and those represented by objective signs or documented by laboratory tests or instrumental procedures (ie, skin rushes, hemorrhagic complications, and electrolytic complications).2 Therefore, the association between depression and adverse drug events cannot be only explained by an overreport of somatic symptoms. Indeed, it has been hypothesized that psychological distress can determine the activation of biological processes, which can result in a reduction of the body's ability to combat pathological processes. This phenomenon, described by Engel3 as the "giving-up–given-up complex," can be responsible for the increased risk of negative outcomes, including adverse drug events, among depressed subjects.3 Finally, an intriguing implication of the findings of Davies et al1 is that psychiatric disorders can represent an important confounding in the association between sex and adverse drug reactions. In fact, it is possible that the direct association between female sex and adverse drug reactions documented by previous observations4,5 could be partially explained by a higher prevalence of depression and anxiety among women compared with men.6 References 1. Davies SJJackson PRRamsay LEGhahramani P Drug intolerance due to nonspecific adverse effects related to psychiatric morbidity in hypertensive patients. Arch Intern Med. 2003;163592- 600PubMedGoogle ScholarCrossref 2. Onder GPenninx BWLandi F et al. Depression and adverse drug reactions among hospitalized older adults. Arch Intern Med. 2003;163301- 305PubMedGoogle ScholarCrossref 3. Engel GL A life setting conducive to illness: the giving-up–given-up complex. Ann Intern Med. 1968;69293- 300PubMedGoogle ScholarCrossref 4. Tran CKnowles SRLiu BAShear NH Gender differences in adverse drug reactions. J Clin Pharmacol. 1998;381003- 1009PubMedGoogle ScholarCrossref 5. Onder GPedone CLandi F et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc. 2002;501962- 1968PubMedGoogle ScholarCrossref 6. Roughan PA Mental health and psychiatric disorders in older women. Clin Geriatr Med. 1993;9173- 190PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Depression and Adverse Drug Reactions

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Depression and Adverse Drug Reactions

Abstract

In their recent article, Davies et al1 reported that among subjects referring to a hypertension clinic, depression was associated with an increased reduction or cessation of antihypertensive drugs owing to an adverse effect that reflected subjective symptoms. This finding would suggest that depressed subjects can amplify somatic symptoms, leading to a higher report rate of adverse drug events. However, in a previous study conducted in a large population of hospitalized older adults, we showed...
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Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.163.19.2395-a
Publisher site
See Article on Publisher Site

Abstract

In their recent article, Davies et al1 reported that among subjects referring to a hypertension clinic, depression was associated with an increased reduction or cessation of antihypertensive drugs owing to an adverse effect that reflected subjective symptoms. This finding would suggest that depressed subjects can amplify somatic symptoms, leading to a higher report rate of adverse drug events. However, in a previous study conducted in a large population of hospitalized older adults, we showed that depressive symptoms were similarly associated with adverse drug reactions represented by subjective symptoms (ie, headache, abdominal pain, and nausea) and those represented by objective signs or documented by laboratory tests or instrumental procedures (ie, skin rushes, hemorrhagic complications, and electrolytic complications).2 Therefore, the association between depression and adverse drug events cannot be only explained by an overreport of somatic symptoms. Indeed, it has been hypothesized that psychological distress can determine the activation of biological processes, which can result in a reduction of the body's ability to combat pathological processes. This phenomenon, described by Engel3 as the "giving-up–given-up complex," can be responsible for the increased risk of negative outcomes, including adverse drug events, among depressed subjects.3 Finally, an intriguing implication of the findings of Davies et al1 is that psychiatric disorders can represent an important confounding in the association between sex and adverse drug reactions. In fact, it is possible that the direct association between female sex and adverse drug reactions documented by previous observations4,5 could be partially explained by a higher prevalence of depression and anxiety among women compared with men.6 References 1. Davies SJJackson PRRamsay LEGhahramani P Drug intolerance due to nonspecific adverse effects related to psychiatric morbidity in hypertensive patients. Arch Intern Med. 2003;163592- 600PubMedGoogle ScholarCrossref 2. Onder GPenninx BWLandi F et al. Depression and adverse drug reactions among hospitalized older adults. Arch Intern Med. 2003;163301- 305PubMedGoogle ScholarCrossref 3. Engel GL A life setting conducive to illness: the giving-up–given-up complex. Ann Intern Med. 1968;69293- 300PubMedGoogle ScholarCrossref 4. Tran CKnowles SRLiu BAShear NH Gender differences in adverse drug reactions. J Clin Pharmacol. 1998;381003- 1009PubMedGoogle ScholarCrossref 5. Onder GPedone CLandi F et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc. 2002;501962- 1968PubMedGoogle ScholarCrossref 6. Roughan PA Mental health and psychiatric disorders in older women. Clin Geriatr Med. 1993;9173- 190PubMedGoogle Scholar

Journal

Archives of Internal Medicine – American Medical Association

Published: Oct 27, 2003

Keywords: depressive disorders,adverse effects of medication

References

  • Drug intolerance due to nonspecific adverse effects related to psychiatric morbidity in hypertensive patients.
    Ghahramani P; Arch Intern Med.
  • Depression and adverse drug reactions among hospitalized older adults.
    Landi F; Arch Intern Med.
  • A life setting conducive to illness: the giving-up–given-up complex.
    Engel GL; Ann Intern Med.
  • Gender differences in adverse drug reactions.
    Shear NH; J Clin Pharmacol.
  • Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA).
    Landi F; J Am Geriatr Soc.
  • Mental health and psychiatric disorders in older women.
    Roughan PA; Clin Geriatr Med.

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