Prescription Opioid Analgesics Increase the Risk of Depression

Scherrer, Jeffrey F.; Švrakić, Dragan M.; Freedland, Kenneth E.; Chrusciel, Timothy; Balasubramanian, Sumitra; Bucholz, Kathleen K.; Lawler, Elizabeth; Lustman, Patrick J.

doi:10.1007/s11606-013-2648-1

Cited by 146 publications

(101 citation statements)

References 32 publications

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“…In addition, our previous study of VHA patients relied on diagnosis of painful conditions without patientreported pain scores and was conducted using a cohort designed for studies of incident heart disease. 21 In this study, we expand our previous research 14,15 to determine (1) whether longer duration of opioid analgesic use is associated with new-onset depression while controlling for dose; (2) whether a higher dose is associated with new-onset depression after adjusting for duration; (3) whether opioid analgesic use remains associated with new-onset depression after controlling for pain scores in VHA patient data; and (4) and whether results generalize to 2 independent health care populations.…”

Section: Introductionmentioning

confidence: 67%

“…In a study of nearly 50,000 Veterans Health Administration (VHA) patients, opioid analgesic use of longer than 180 days, compared with 1 to 90 days, was associated with significantly greater risk (hazard ratio [HR] = 1.51; 95% CI, 1.31-1.74) of a new diagnosis for depression. 14 In a prospective study of chronic pain patients, those who increased their MED to more than 50 mg/d, compared with nonusers, had a 2.6 times greater probability of depression with time. 15 These results remained after rigorous control for confounding.…”

Section: Introductionmentioning

confidence: 99%

“…A fuller understanding of opioid-related depression is relevant to primary care in light of the increased provision of pain management in this setting. 20 Our prior studies of the link between opioid analgesic use and depression have several limitations, 14,15 including unknown generalizability to other US health care populations, and uncertainty as to whether duration and dose are both associated with depression. In addition, our previous study of VHA patients relied on diagnosis of painful conditions without patientreported pain scores and was conducted using a cohort designed for studies of incident heart disease.…”

Section: Introductionmentioning

confidence: 99%

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Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations

Scherrer

Salas

Copeland

et al. 2016

The Annals of Family Medicine

185

173

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PURPOSE Recent results suggests the risk of a new onset of depression increases with longer duration of opioid analgesic use. It is unclear whether new-onset depression related to opioid analgesic use is a function of the dose prescribed or the duration of use or both.METHODS Using a retrospective cohort design, we collected patient data from 2000 to 2012 from the Veterans Health Administration (VHA), and from 2003 to 2012 from both Baylor Scott & White Health (BSWH) and the Henry Ford Health System (HFHS). Patients (70,997 VHA patients,13,777 BSWH patients,and 22,981 HFHS patients) were new opioid users, aged 18 to 80 years, without a diagnosis of depression at baseline. Opioid analgesic use duration was defined as 1 to 30, 31 to 90, and more than 90 days, and morphine equivalent dose (MED) was defined as 1 to 50 mg/d, 51 to 100 mg/d, and greater than 100 mg/d of analgesic. Pain and other potential confounders were controlled for by inverse probability of treatment-weighted propensity scores.RESULTS New-onset depression after opioid analgesic use occurred in 12% of the VHA sample, 9% of the BSWH sample, and 11% of the HFHS sample. Compared with 1-to 30-day users, new-onset depression increased in those with longer opioid analgesic use. Risk of new-onset depression with 31 to 90 days of opioid analgesic use ranged from hazard ratio [HR] = 1.18 (95% CI, 1.10-1.25) in VHA to HR = 1.33 (95% CI, 1.16-1.52) in HFHS; in opioid analgesic use of more than 90 days, it ranged from HR = 1.35 (95% CI, 1.26-1.44) in VHA to HR = 2.05 (95% CI, 1.75-2.40) in HFHS. Dose was not significantly associated with a new onset of depression.CONCLUSIONS Opioid-related new onset of depression is associated with longer duration of use but not dose. Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression. Opioid analgesic use, not just pain, should be considered a potential source when patients report depressed mood. Ann Fam Med 2016;14:54-62. doi: 10.1370/afm.1885. INTRODUCTIOND epression co-occurs with chronic noncancer pain 1,2 and is known to be associated with opioid use. Patients with chronic noncancer pain and depression are more likely than those without depression to receive opioids, 3 have a longer duration of use, 4,5 take them at higher morphine equivalent doses (MEDs), 6 and misuse and or abuse opioids. 7,8 A review of psychopathology in pain 9 suggests the opioid epidemic in the United States reflects underdetected and undertreated mental illness in patients with chronic pain.Every year more than 200 million prescriptions for opioids are written in the United States. 10 Known consequences of this opioid epidemic include abuse and accidental overdose.11-13 A less understood adverse outcome and emerging line of inquiry is the association between opioid use and risk of depression. In a study of nearly 50,000 Veterans Health Administration (VHA) patients, opioid analgesic use of longer than 180 14 In a prospective study of chronic pain patients, thos...

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Section: Introductionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations

Scherrer

Salas

Copeland

et al. 2016

The Annals of Family Medicine

185

173

View full text Add to dashboard Cite

show abstract

“…No se han publicado estudios que hayan comparado el LTOT (> 1 año) versus placebo, sin opioide, o con otras terapias no opioides (2). En las últimas décadas, este aumento en la prescripción de medicamentos opioides ha estado acompañado de aumento de sobredosis (3), así como de mayor incidencia del trastorno por uso de opioides, depresión, fractura, accidentes de tráfico y suicidio (4)(5)(6)(7)(8). La reducción de dosis, descontinuación o disminución del opioide puede disminuir estos riesgos, y las directrices de expertos recomiendan estas actitudes cuando los riesgos sobrepasan los beneficios (9).…”

Section: Sr Directorunclassified

La disminución de opioides puede mejorar los resultados de los pacientes con dolor crónico

Montero¹,

Curado²

2017

Rev. Soc. Esp. Dolor.

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“…Using propensity-score methods and administrative billing records, including medical encounter and prescription dispensing data from the Veterans Administration health care system (VA), the authors investigated whether duration of prescription opioid use was associated with increased risk of incident depression over up to 7-year follow-up. 4 Among nearly 50,000 individuals who filled a first prescription for an opioid, 91 % discontinued use by 90 days. However, the four percent who continued use between 90 and 180 days had 25 % higher risk of receiving a diagnostic code for major depression, and those with even longer use had 50 % higher risk.…”

mentioning

confidence: 99%