8. Proton pump inhibitors and H2 blockers
Why they're prescribed: Doctors typically prescribe these medications, which suppress the secretion of gastric acid, to treat gastroesophageal reflux disease (GERD).
How they can cause depression: While these drugs are known to cause depression, scientists don't yet understand why they do. When any major body process is blocked, however, the body often rebels in an intense effort to fight back. Consequently, it's altogether likely that changing the pH of the stomach could bring on changes to the central nervous system and the brain.
Alternatives: Know which foods trigger your acid reflux (spicy or fried foods, for example) and avoid them, especially in the hours before bedtime. A non-calcium-carbonate-based antacid, such as Mylanta, may also help. Many of my patients have reported relief from the home remedy of apple cider vinegar and honey (typically one tablespoon each, taken together), though I know of no scientific research that confirms the effectiveness of this approach.
9. Statins and other lipid-lowering drugs
Why they're prescribed: Statins are the class of drugs most commonly prescribed to lower cholesterol levels, followed by fibrates and other drugs, such as ezetimibe, colesevelam and nicotinic acid.
How they can cause depression: Recent research suggests that lipid-lowering drugs may cause depression by depleting levels of cholesterol in the brain, where it plays an important role in the release of neurotransmitters.
Alternatives: A combination of vitamin B12 (injectable or sublingual), vitamin B6, folic acid and fish oil can lower homocysteine levels in the body. Homocysteine, an amino acid, inflicts damage to the inner arterial lining (endothelium) and other cells of the body, elevating lipids levels. While there are many studies that substantiate this nondrug approach and many that reject it, I've found that it works consistently well in older patients without posing the risk of serious side effects.
10. Anticholinergic drugs used to treat stomach cramps and other GI disorders
Why they're prescribed: Anticholinergic medications slow the action of the intestine, thereby reducing the amount of stomach acid produced. They do this mostly by blocking the effects of acetylcholine, the neurotransmitter that causes muscles — including those in the intestine — to contract. Dicyclomine (Bentyl), for example, is widely used to treat the symptoms of irritable bowel syndrome.
How they can cause depression: Anticholinergics, as central nervous system depressants, can cause depression, sedation and cognitive impairment in older patients.
Alternatives: Using an H2 blocker such as ranitidine (Zantac) in the lower-dose formulation (75mg) can work well for the occasional attack of heartburn and acid indigestion. A calcium-free antacid (Gelusil or Mylanta, for example) may help.