Jeffrey Scherrer, Ph.D., professor of family and community medicine at Saint Louis
University and his co-authors have found depression is a consequence of chronic opioid
use. In the current study, they find that patients with chronic prescription opioid
use and depression who adhered to anti-depressant medications were more likely to
Exploratory analysis found that patients who adhered to anti-depression medications
and stopped taking opioids experienced a rapid and greater decline in depression symptoms
compared with patients who did not stop taking 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 said. “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.”
Long-term prescription opioid analgesic use (OAU) for chronic non-cancer pain is defined
as daily or near-daily use for 90 days. Between 1.4 and 10 percent of patients with
a new opioid prescription develop chronic OAU and a majority (65-80 percent) of patients
who have persistent opioid analgesic use for 90 days are still taking opioids three
to five years later.
These long-term patients are more likely than those that use opioids for a short term
to develop opioid disorder and overdose. Chronic analgesic use is also associated
with new depressive episodes and treatment-resistant depression.
“Effective depression treatment may break the mutually reinforcing opioid-depression
relationship and increase the likelihood of successful opioid cessation,” Scherrer
The study authors used a retrospective cohort design to compare adherence to anti-depressants
versus non-adherence in patients with chronic non-cancer pain who were 90 day-plus
prescription opioid users. Previous studies have shown the odds of depression improvement
are markedly greater in patients who adhere to anti-depressants.
Scherrer and his co-authors used medical record data from 2000-2012 from the Veterans
Health Administration (VHA).
A random sample of 500,000 patients was taken from a cohort of 2,910,335 identified
with at least one out-patient visit in both fiscal years 1999 and 2000. The patients
were ages 18 to 80 and excluded patients with an HIV or cancer diagnosis. Patients
must have had at least one yearly visit in 2000-2001 during which they must have been
free of a medical record depression diagnosis. All patients developed depression following
more than 90 days of continuous prescription opioid use.
The odds of opioid cessation were compared between patients with anti-depressant adherence
The anti-depression medications included monoamine oxidase inhibitors (MAOIs), selective
serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors
(SNRIs), tricyclics (TCAs) and non-classified ADMs.
The study calls for additional research and treatment trials.
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, Missouri.; Mark D. Sullivan, M.D., of the Department of Psychiatry
and Behavioral Health, University of Washington School of Medicine, Seattle, Washington;
Brian K. Ahmedani, Ph.D., Henry Ford Health System, Center for Health Policy and Health
Services, Detroit, Mich.; Laurel A. Copeland, Ph.D., VA Central Western Massachusetts
Healthcare System, Leeds, Massachusetts, Center for Applied Health Research, Baylor
Scott & White Health, Temple, Texas and UT Health San Antonio, Texas; Kathleen K.
Bucholz, Ph.D., Department of Psychiatry, Washington University School of Medicine,
St. Louis, Missouri; Thomas Burroughs, Ph.D., Saint Louis University Center for Outcomes
Research, St. Louis, Missouri; F. David Schneider, M.D., MSPH, Department of Family
and Community Medicine, Saint Louis University, St. Louis, Mo.; and Patrick J. Lustman,
Ph.D., Department of Psychiatry, Washington University School of Medicine, St. Louis,
Missouri, and the Bell Street Clinic, VA St. Louis Health Care System – John Cochran
Division, St. Louis, Missouri.
This study was supported by the National Institute of Mental Health, Prescription
Opioid Analgesics and Risk of Depression, R21MH101389.
Established in 1836, Saint Louis University School of Medicine has the distinction
of awarding the first medical degree west of the Mississippi River. The school educates
physicians and biomedical scientists, conducts medical research, and provides health
care on a local, national and international level. Research at the school seeks new
cures and treatments in five key areas: cancer, liver disease, heart/lung disease,
aging and brain disease, and infectious diseases.