Does Popular Asthma Medication Singulair Cause Depression?

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Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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People with asthma often experience anxiety and depression. And on the flip side, depression is associated with poor adherence to medication and worse asthma outcomes. So, what’s the connection between these health conditions?  

Then, there’s the question of whether asthma medications themselves cause depression. In 2009, the FDA required packaging for the Singulair generic, montelukast, to have a warning that the popular asthma medication may cause behavioral side effects—including depression and suicidal thoughts. That caused some folks to stop taking their asthma med and wonder if it was causing depression. Let’s see.



Does asthma cause depression?

That’s the first question to ask, and it’s unlikely that asthma causes depression. In a meta-analysis of more than 25,000 patients, researchers found that having asthma was not associated with later depression. On the contrary, a meta-analysis of more than 83,000 patients found that having depression was associated with subsequent onset of asthma—a person with depression is 1.4 times more likely to develop adult-onset asthma. In other words, depression was found to be a small risk factor for asthma.


Is it possible that asthma drugs cause depression?

It might actually be the other way around. A very recent study found that 32% of albuterol over-users were at risk of clinical depression compared with 17% of patients using albuterol the expected amount. Albuterol is a popular drug in asthma inhalers. So, what’s going on here?

The study above found that the risk of depression in albuterol over-users was almost twice as high as the risk in albuterol expected-users. That shows us that patients with mild asthma and depression may be overusing their albuterol, not that albuterol causes depression. This makes some sense, if you have more anxiety and sadness, you may experience more chest pressure and reach for your albuterol.


What is the depression warning for montelukast?  

In 2009, the FDA placed a warning on montelukast (Singulair) because of reports of behavioral side effects, including depression, suicide ideation and suicidal behavior. At the same time, an analysis performed by Merck added that “serious behavior-related events were rare,” but folks wondered if they should really trust the drug company who makes the medication.


Does montelukast really cause depression?

In a recent study of 4450 folks who filled both montelukast and antidepressant prescriptions, researchers found a weak link between having montelukast and filling a subsequent antidepressant prescription. Those results suggest that depression may be related to asthma, rather than to montelukast. (Back to our first point.) So, there is a lack of convincing evidence that montelukast causes depression or suicidal thoughts.

But, maybe reading it is believing it?

After the label-change warning in 2009 on Singulair, researchers looked at medical charts of over 100,000 people and found an abrupt reduction in use of montelukast, especially among young adults. So, people got worried—and rightly so. There was also a small increase in mental health visits among Singulair users.

What’s the point here? The FDA label change for Singulair communicated a possible risk of depression. That communication and enhanced awareness may have caused patients to seek help for mental health symptoms more frequently.


Are all drugs like montelukast linked to depression?

Leukotriene receptor antagonists like montelukast inhibit molecules that cause bronchoconstriction (tightening of the airways) and taken daily may improve asthma symptoms. Zafirlukast (Accolate) is the other medication in this class and the drug information for zafirlukast is the same as that for montelukast—so the depression warning holds for both.


Dr O.

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