Causes
* Drugs with evidence of a link to depression or mania include the following:
o Flunarizine - Epidemiologic survey, adverse effect noted in several clinical trials
o Corticosteroids - Prospective cohort study, cross-sectional medicine patients
o Digoxin - Prospective cohort study, cross-sectional epidemiologic study
o Minor tranquilizers - Prospective cohort study
o Sedatives - Prospective cohort study
o Interferon beta-1b, peginterferon alfa-2b - Very significantly increased incidence in randomized controlled trials (RCTs), although trials were not designed to study this as an endpoint
o Amantadine - Increased incidence in RCTs, although trials were not designed to study this as an endpoint
o Isocarboxazid - Increased incidence in RCTs, although trials were not designed to study this as an endpoint
o Levetiracetam - Increased incidence in RCTs, although trials were not designed to study this as an endpoint
* Drugs with weak or conflicting evidence of a link to depression or mania include the following:
o ACE inhibitors - Prescription sequence symmetry analysis
o Propranolol and nadolol (ie, lipophilic beta-blockers) - Meta-analysis of antihypertensive clinical trials, record linkage studies
o Norplant - Series of case reports
o Leuprolide - Case series
o Isotretinoin - Case reports
o Antidepressants (ie, citalopram, bupropion, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, sertraline, venlafaxine) - Case reports
Differential Diagnoses
Adjustment Disorders
Alcoholism
Anxiety Disorders
Dysthymic Disorder
Hypothyroidism
Other Problems to Be Considered
Adrenal Insufficiency and Adrenal Crisis
Delirium, Dementia, and Amnesia
Substance-Induced Mood Disorders, Depression and Mania
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