Study led by Saint Louis University’s Dr. Jeffrey Scherrer is published in the Annals of Family Medicine.
Opioids may cause short-term improvement in mood, but long-term use imposes risk of new-onset depression, a Saint Louis University study shows.
The study, “Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations,” was published online Jan. 11 in the Annals of Family Medicine. Jeffrey Scherrer, Ph.D., associate professor for family and community medicine at Saint Louis University, and his co-authors speculate that findings may be explained by long-term opioid use of more than 30 days leading to changes in neuroanatomy and low testosterone, among other possible biological explanations. The link was independent of the known contribution of pain to depression, and the study calls on clinicians to consider the contribution of opioid use when depressed mood develops in their patients.
“Opioid-related new onset of depression is associated with longer duration of use but not dose,” Scherrer wrote. “Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression.”
The study calls for additional research to identify which patients are most vulnerable to opioid-related depression.
Scherrer and his co-authors collected patient data from 2000-2012 from the Veterans Health Administration (VHA), Baylor Scott & White Health (BSWH), and the Henry Ford Health System (HFHS).
The data sets were comprised of 70,997 VHA patients, 13,777 BSWH patients and 22,981 patients from HFHS. The patients were new opioid users, ages 18 to 80, without a diagnosis of depression when they began taking medication.
The study expands on Scherrer’s previous study of VA patients and opioids to determine:
- Whether taking an opioid for a longer period of time is associated with new-onset depression while controlling for dose;
- Whether a higher dose of opioids is associated with new-onset depression after adjusting for duration;
- Whether opioid analgesic use remains associated with new-onset depression after controlling for pain scores in VHA patient data; and
- Whether results generalize to two independent health care populations.
Twelve percent of the VHA sample, 9 percent of the BSWH sample and 11 percent of the HFHS sample experienced new-onset depression after opioid analgesic use.
“Findings were remarkably consistent across the three health care systems even though the systems have very different patient characteristics and demographics,” Scherrer said. In all three patient populations, longer duration of opioid analgesic use was associated with new-onset depression after controlling for pain and daily morphine equivalent doses.
The authors note that research on the efficacy of opioids in depression treatment, while limited by small samples, short follow-up times and lack of control groups, does not support opioids as an effective long-term treatment for depression.
Opioid drugs in the study included codeine, fentanyl, hydrocodone, hydromorphone, levorphanol, meperidine, oxycodone, oxymorphone, morphine and pentazocine.
Other authors include Joanne Salas, MPH, of the Department of Family and Community Medicine at Saint Louis University and Harry S. Truman Veterans Administration Medical Center, Columbia, Mo.; Laurel A. Copeland, Ph.D., Center for Applied Health Research, Baylor Scott and White Health, Central Texas Veterans Health Care System, Temple, Texas, Texas A&M Health Science Center, Bryan, Texas, and University of Texas Health Science Center, San Antonio, Texas; Eileen M. Stock, Ph.D., Center for Applied Health Research, Baylor Scott and White Health, Central Texas Veterans Health Care System, Temple, Texas, and Texas A&M Health Science Center, Bryan, Texas; Brian K. Ahmedani, Ph.D., Henry Ford Health System, Center for Health Policy and Health Services, Detroit, Mich.; Mark D. Sullivan, M.D., Department of Psychiatry and Behavioral Health, University of Washington School of Medicine, Seattle, Wash.; Thomas Burroughs, Ph.D., Saint Louis University Center for Outcomes Research, St. Louis, Mo.; F. David Schneider, M.D., MSPH, Department of Family and Community Medicine, Saint Louis University, St. Louis, Mo.; Kathleen K. Bucholz, Ph.D., Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo.; and Patrick J. Lustman, Ph.D., Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo., and the Bell Street Clinic, VA St. Louis Health Care System – John Cochran Division, St. Louis, Mo.
Funding: This study was supported by the National Institute of Mental Health, Prescription Opioid Analgesics and Risk of Depression, R21MH101389.
Source: Maggie Rotermund – Saint Louis University
Image Credit: The image is credited to Rotellam1 and is licensed CC BY SA 3.0
Original Research: Abstract for “Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations” by Jeffrey F. Scherrer, PhD, Joanne Salas, MPH, Laurel A. Copeland, PhD, Eileen M. Stock, PhD, Brian K. Ahmedani, PhD, Mark D. Sullivan, MD, Thomas Burroughs, PhD, F. David Schneider, MD, MSPH, Kathleen K. Bucholz, PhD and Patrick J. Lustman, PhD in Annals of Family Medicine. Published online January 2016 doi:10.1370/afm.1885
Abstract
Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations
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.
“Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations” by Jeffrey F. Scherrer, PhD, Joanne Salas, MPH, Laurel A. Copeland, PhD, Eileen M. Stock, PhD, Brian K. Ahmedani, PhD, Mark D. Sullivan, MD, Thomas Burroughs, PhD, F. David Schneider, MD, MSPH, Kathleen K. Bucholz, PhD and Patrick J. Lustman, PhD in Annals of Family Medicine. Published online January 2016 doi:10.1370/afm.1885
