Study: Treatment of Depression Could Help Curb Opioid Use

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Study: Treatment of Depression Could Help Curb Opioid Use

By Beth Leipholtz 02/07/18

New research suggests that addressing depression in long-term prescription opioid users may make treatment more effective.

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Depression may hold some patients back.

According to a study published in the February issue of the British Journal of Psychiatry, patients who struggled with chronic prescription opioid use as well as depression were more likely to stop using opioids if their depression was treated with an antidepressant.

The Deccan Chronicle states that Jeffrey Scherrer, a professor of family and community medicine at Saint Louis University and one of the study’s authors, says he and his co-authors found through the study that depression is a “consequence of chronic opioid use.”

Analysis of the study, "Impact of adherence to antidepressants and on long-term prescription opioid use," found that patients who took antidepressants and stopped opioid use reported a faster reduction in depression compared with patients who continued to use opioids.

"We can't be sure that a decrease in depression led to patients' choosing to stop opioid use and we know prospective studies are needed," Scherrer told the Deccan Chronicle. "Depression can worsen pain and is common in patients who remain long-term prescription opioid users. Our study should encourage clinicians to determine if their non-cancer pain patients are suffering from depression and aggressively treat patients' depression to reduce opioid use."

When it comes to opioid use, the Chronicle reports that long-term prescription opioid analgesic use for chronic pain not related to cancer is defined as daily or almost-daily use for 90 days. Of patients with an opioid prescription, between 1.4-10% develop opioid analgesic use. Of those, 65-80% are still taking opioids three to five years later. Chronic opioid use is also linked to “depressive episodes and treatment-resistant depression,” states the Chronicle.

"Effective depression treatment may break the mutually reinforcing opioid-depression relationship and increase the likelihood of successful opioid cessation," said Scherrer.

Scherrer and his co-authors utilized data from medical records from the Veterans Health Administration, spanning the years of 2000 to 2012.

In the study, a random sample of 500,000 patients was taken from a pool of 2,910,335 determined to have had at least one outpatient visit in both fiscal years 1999 and 2000. Patients ranged in age from 18 to 80 and did not include HIV or cancer patients. These patients must have had at least one annual visit between 2000 and 2001 during which they did not have a medical record diagnosis of depression. Following 90 or more days of opioid use, these patients developed depression.

Antidepressants in this study included monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclics and non-classified ADMs.

The connection between depression and opioids isn’t a new one.

According to a study published in the Journal of the American Board of Family Medicine, more than half of opioid prescriptions in the U.S. are given to patients who already suffer from disorders such as depression, anxiety and other mood disorders. Another study claims that those with a history of depression have a greater risk of developing chronic pain, which means they may be prescribed opioids.

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