More than a third of all Americans were prescribed 1 or more drugs that have been tied to the adverse events of depression or suicidal ideation, according to a study published in JAMA.

Furthermore, the study reported that the prevalence of depression was 15% for those who reported use of 3 or more medications concurrently with depression as an adverse effect. Patients who were prescribed at least 3 medications reported 3 times as many instances of depression compared with individuals who were not taking any medications.

The types of drugs identified as being linked to depression and suicide include: birth control medications, beta blockers, steroids, sedatives, proton pump inhibitors, and a number of cancer therapy medications.

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More than 200 drugs were found to list depression or suicidal symptoms as adverse effects, including the cancer-focused medications.

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The list, though, was hardly comprehensive. In all, it identified 7 oncology medications, some of which were used as direct therapeutic agents for cancer and others, as in the case of the antiemetic dronabinol, that are prescribed as supportive therapies to help patients tolerate the negative effects of other treatments. While the study made mention of erlotinib and tamoxifen, for example, it did not include other drugs known to be linked to depression, such as temozolomide or asparaginase.

“One thing that we’ve advocated [for] is awareness, because I think a lot of patients and physicians might not necessarily be aware of [depression as a potential side effect] ,” Paul Nguyen, MD, director of the genitourinary clinical center for radiation oncology and vice-chair for clinical research in the department of radiation oncology at the Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center in Boston, Massachusetts, said in a telephone interview with Cancer Therapy Advisor.

“Now sometimes you just have to give the drug,” he continued. “In some cases, patients just really need it to stay alive. So, you have to accept those side effects. But there are definitely borderline cases where [these side effects are] something that tilts the risk-benefit for select patients.”

The issue may be of particular concern for patients with cancer because they report much higher rates of depression compared with the general population.

“Cancer survivors in the United States reported medication use for anxiety and depression at rates nearly 2 times those reported by the general public, likely a reflection of greater emotional and physical burdens from cancer or its treatment,” wrote a group of researchers from the Centers for Disease Control and Prevention (CDC).2

Similarly, the suicide rate among patients with cancer is about double that of individuals with no history of cancer, according to an analysis of 3,604,229 patients in the Surveillance, Epidemiology, and End Results (SEER) database.Across 40 years of data, researchers found 6661 suicides associated with a cancer diagnosis.