Can Crexont cause depression and anxiety?

Crexont (Apremilast) Can Cause Depression and Anxiety

Yes, Crexont (apremilast) can cause depression and anxiety, with depression reported in approximately 1% of patients taking the medication. 1

Evidence on Depression and Anxiety with Apremilast

• Apremilast may be associated with the emergence or worsening of depression, requiring discussion of this risk with patients before starting therapy 1
• Healthcare providers should counsel patients about the potential for depression and anxiety before initiating treatment to prevent worsening of pre-existing depression or suicidality 1
• The FDA-approved labeling for apremilast specifically mentions depression as a potential adverse effect that requires monitoring 1

Psychiatric Side Effects Profile

• Depression is specifically mentioned in the guidelines as a reported adverse effect in approximately 1% of patients taking apremilast 1
• While anxiety is not specifically listed as a common side effect in the available evidence, psychiatric symptoms can occur with many medications that affect inflammatory pathways 1
• The most common adverse effects of apremilast are diarrhea, nausea, upper respiratory tract infections, and headache, which could potentially contribute to psychological distress in some patients 1

Risk Factors and Monitoring

• Patients with pre-existing depression or anxiety may be at higher risk for worsening of these conditions when taking apremilast 1
• Regular monitoring for mood changes, depression, and anxiety symptoms is advisable during apremilast treatment 1
• Weight loss of 5-10% occurred in 12% of patients treated with apremilast (compared to 5% with placebo), which could potentially contribute to psychological effects in some patients 1

Management Recommendations

• If depression or anxiety emerges or worsens during apremilast treatment, consider discontinuation of the medication 1
• For patients experiencing significant weight loss (>5% from baseline) which could contribute to psychological distress, discontinuation of apremilast should be considered 1
• Patients should be informed about the potential psychiatric side effects before starting treatment so they can report any mood changes promptly 1

Comparison with Other Medications

• Many systemic medications can cause psychiatric side effects, including corticosteroids which can cause both euphoria/hypomania (short-term use) and depression (long-term use) 2
• Antidepressants, which are often used to treat depression and anxiety, can themselves have psychiatric side effects, including increased risk for nonfatal suicide attempts with SSRIs 1
• When comparing apremilast to other medications, the 1% incidence of depression is relatively low compared to some other systemic therapies 1, 2

Clinical Perspective

• The risk of depression with apremilast should be weighed against its benefits and the risks of alternative treatments 1
• For patients with a history of depression or anxiety, closer monitoring may be warranted if apremilast therapy is initiated 1
• The overall safety profile of apremilast is generally favorable, allowing its use in patients with complex medical issues where other systemic agents might be contraindicated 1