By Kayt Sukel
Depression is a condition that often presents with other chronic medical conditions. A patient who is prescribed an antidepressant may also be taking a variety of other medications—a situation that doctors and pharmacists call “polypharmacy.” And according to Andrew Straw, Pharm.D., Assistant Professor of Pharmacy Practice at Cedarville University, polypharmacy is something that needs to be closely monitored.
“Any time more medications are added to a patient’s profile, we see an increased risk for negative outcomes. This might be due to a drug interaction or some kind of interaction with a patient’s lifestyle or diet,” Straw says. “But simply stated, the more medications a person is taking, the more likely it is that there will be a problem that the doctor didn’t intend for, something that may end up harming the patient.”
And that includes common over-the-counter medications—the everyday pain relievers or allergy medications you can pick up at your local grocery store or pharmacy.
“Most people don’t consider over-the-counter medications as being medicine. They don’t consider herbal supplements or vitamins to be medicine. And that can become tricky because some of these medications definitely can interact with certain prescription medications,” says Straw. “What that means is that everything has to be accounted for, your prescriptions and any other medications or supplements you may be taking at home.”
What are some common over-the-counter meds that may cause unintended interactions with anti-depressant medication? Even common painkillers, nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Naproxen—the same pills many people take for headaches or arthritis pain without a second thought—may cause issues.
“When you combine NSAIDs with selective serotonin re-uptake inhibitors (SSRIs) or tricyclics, you can have an increased risk of bleeding,” says Straw. “You can also have problems with certain antihistamines that may result in excessive dryness in the eyes or a condition called serotonin syndrome, which involves feelings of restlessness, rapid heart rate, and high blood pressure. And some medications you might take for heartburn may increase the level of antidepressants, causing them to have a higher dose than intended.”
Pharmacogenomic testing can potentially reduce some polypharmacy issues by helping physicians to initially select the best antidepressant medication and dosage, Straw says. But a large portion of polypharmacy problems also come from the side effects of current medications being mistaken for new conditions that require treatment. And because of that, he strongly encourages patients who are taking antidepressant medication to make sure that their doctors and pharmacists are aware of every drug, vitamin, and pill they are taking, prescription or otherwise.
“We need to remember that just because an agent is over-the-counter or touted as ‘natural’ or ‘safe’ does not necessarily mean that it can’t cause problems. Every patient is different and we can reduce issues if we know exactly what someone is taking and for what,” he says.
But he also says that patients should make sure they are following the letter of the label when taking over-the-counter meds. “Most of these medications are not meant to be chronically used day-in and day-out without any doctor intervention,” Straw says. “So making sure to limit that self-care to the appropriate amount of time on the labeling is a safe-check system to make sure there isn’t something more serious going on with the patient that the doctor needs to address.”
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