What psychotropic medications might induce depressive symptoms?

From the Guidelines

Certain psychotropic medications, including some antidepressants, antipsychotics, and benzodiazepines, can induce depressive symptoms as a side effect. When considering the potential for psychotropics to induce depressive symptoms, it's crucial to evaluate the medication's side effect profile. According to 1, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline are associated with sexual dysfunction and an increased risk of suicide attempts compared to placebo. Some key points to consider include:

• The American College of Physicians recommends regular assessment of patient status, therapeutic response, and adverse effects of antidepressant therapy, beginning within 1 to 2 weeks of initiation of therapy 1.
• Medications like bupropion have a lower rate of sexual adverse events compared to fluoxetine or sertraline, while paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 1.
• The U.S. Food and Drug Administration advises close monitoring of patients receiving antidepressants for increases in suicidal thoughts and behaviors, particularly during the first 1 to 2 months of treatment 1. It's essential to discuss adverse event profiles with patients before selecting a medication and to modify treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of initiation 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Psychotropics that Might Induce Depressive Symptoms

• The following psychotropics have been linked to the induction of depressive symptoms:
  • Corticosteroids 2
  • Interferon-alpha 2
  • Interleukin-2 2
  • Gonadotropin-releasing hormone agonists 2
  • Mefloquine 2
  • Progestin-releasing implanted contraceptives 2
  • Propranolol 2
• Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and mirtazapine, may also induce depressive symptoms in some individuals, particularly when used at higher doses or in combination with other medications 3, 4
• Atypical antipsychotics, such as olanzapine and quetiapine, may be associated with a lower risk of inducing depressive symptoms compared to other psychotropics 5

Specific Medications and their Association with Depressive Symptoms

• SSRIs: may induce depressive symptoms, particularly in children and young adults aged 18-24, due to an increased risk of suicidality 6
• Venlafaxine: may induce depressive symptoms, particularly at higher doses 4
• Mirtazapine: may induce depressive symptoms, particularly at higher doses 4
• Olanzapine: may be associated with a lower risk of inducing depressive symptoms compared to other psychotropics 5
• Quetiapine: may be associated with a lower risk of inducing depressive symptoms compared to other psychotropics 5