The risk for developing depression may be up to twice as high in people receiving long-term opioids as it is in those taking these medications for shorter periods—over and above the depression inherently associated with having chronic pain, according to new study data (Ann Fam Med 2016;14:54-62). The researchers did not find a link between depression and opioid dose.
A 10-member research team reviewed outcome data from tens of thousands of patients who had been treated at one Veterans Affairs (VA) hospital and two private hospitals. They found that, after rigorously controlling for pain and other factors related to both opioid use and depression, the risk for new-onset depression with more than 90 days of opioid analgesic use compared with shorter-term use ranged from 1.35 to 2.05.
“We need to treat people who are taking prescription opioids with respect. And if they develop depression they may need help getting off opioids, and we need to give them the resources to do that,” lead investigator Jeffrey Scherrer, PhD, associate professor and research director, Department of Family and Community Medicine, Saint Louis University School of Medicine, told Pain Medicine News.
Another expert agrees there appears to be a link between chronic opioid treatment and depression, but defends what he sees as a positive aspect of long-term opioid use.
“It is commonly observed that people with chronic, year-after-year, pain may become clinically depressed, and opioid treatment may be a factor in contributing to the onset of depression as well as perpetuating it,” commented pain physician Ezra B. Riber, MD, who runs Palmetto Pain Management in Columbia, S.C.; is president of the South Carolina Society of Interventional Pain Physicians; and is president-elect of the Pain Society of the Carolinas.
“[On the other hand,] in support of opioid use, there is some evidence that chronic pain stimuli can downregulate central <03BC>-opioid transmission, so opioids may still be the best option in some individuals while their depression is addressed separately with medication and/or formal counseling,” said Dr. Riber.
Dr. Scherrer and his collaborators had published two other studies on this topic, both pointing to the same result but with smaller or selected patient populations. In the new study, they included a larger patient sample from both the VA and private hospitals, and analyzed both opioid dose and duration.
The team focused on electronic medical record data from 2002 to 2012 in the VA, and from 2005 to 2012 in the Baylor Scott & White Health system and the Henry Ford Health System.
Among the 107,755 patients in the study, the proportion of new-onset depression rose with length of opioid use. After weighting the data and adjusting further for potential persistent painful conditions, the researchers calcu lated a hazard ratio of 1.18 for new-onset depression with 31 to 90 versus one to 30 days of opioid use, and a hazard ratio of 1.35 for new-onset depression with more than 90 days of opioid use versus one to 30 days.
However, the investigators did not find a significant association between opioid dose and incidence of new-onset depression. This was corroborated by their rigorous propensity-score data weighting analysis, which revealed there were no significant associations between pain, other confounders, and duration and dose exposure. The opioid exposure–depression relationship was independent of contributions from pain.
“We know opioids work great for short-term pain management, but we don’t have good evidence in the literature for whether they’re effective in the long term,” said Dr. Scherrer. “We already know there are some dangerous side effects such as overdose and abuse, and I think that depression is another potential serious side effect from long-term opioid use.”
—Rosemary Frei, MSc
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