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J Pain. 2016 Apr;17(4):473-82. doi: 10.1016/j.jpain.2015.12.012. Epub 2016 Feb 13.

Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients.

Author information

1
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Research Service, Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri; Saint Louis University Center for Outcomes Research, St. Louis, Missouri. Electronic address: scherrjf@slu.edu.
2
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Research Service, Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri.
3
Center for Applied Health Research, Baylor Scott & White Health, and Central Texas Veterans Health Care System, Temple, Texas; Department of Medicine, Texas A&M Health Science Center, Bryan, Texas; Department of Psychiatry, UT Health Science Center, San Antonio, Texas.
4
Center for Applied Health Research, Baylor Scott & White Health, and Central Texas Veterans Health Care System, Temple, Texas; Department of Medicine, Texas A&M Health Science Center, Bryan, Texas.
5
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
6
Department of Psychiatry and Behavioral Health, University of Washington School of Medicine, Seattle, Washington.
7
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
8
Saint Louis University Center for Outcomes Research, St. Louis, Missouri.
9
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Mental Health Service, The Bell Street Clinic, VA St. Louis Health Care System - John Cochran Division, St. Louis, Missouri.

Abstract

Several studies have shown that chronic opioid analgesic use is associated with increased risk of new-onset depression. It is not known if patients with remitted depression are at increased risk of relapse after exposure to opioid analgesics. A retrospective cohort design using patient data from the Veterans Health Administration (VHA; n = 5,400), and Baylor Scott & White Health (BSWH; n = 842) was performed with an observation period in the VHA from 2002 to 2012 and in the BSWH from 2003 to 2012. Eligible patients had a diagnosis of depression at baseline and experienced a period of remission. Risk of depression recurrence was modeled in patients that either started taking an opioid or continued without opioid prescriptions before or during remission. Cox proportional hazard models were used to measure the association between opioid use and depression recurrence controlling for pain, and other confounders. Patients exposed to an opioid compared with those unexposed had a significantly greater risk of depression recurrence in both patient populations (VHA: hazard ratio [HR] = 2.17, 95% confidence interval [CI], 2.01-2.34; BSWH: HR = 1.77; 95% CI, 1.42-2.21). These results suggest opioid use doubles the risk of depression recurrence even after controlling for pain, psychiatric disorders, and opioid misuse. Further work is needed to determine if risk increases with duration of use. Repeated screening for depression after opioid initiation may be warranted.

PERSPECTIVE:

In 2 large patient cohorts with large differences in demographic characteristics and comorbidity, patients with remitted depression who were exposed to opioid analgesics were 77% to 117% more likely to experience a recurrence of depression than those who remained opioid -free. Routine, not just at initiation of treatment, screening for depression is warranted.

KEYWORDS:

Opioids; depression recurrence; epidemiology; pain; retrospective

PMID:
26884282
PMCID:
PMC4890716
DOI:
10.1016/j.jpain.2015.12.012
[Indexed for MEDLINE]
Free PMC Article

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