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Prev Med. 2016 Oct;91:110-116. doi: 10.1016/j.ypmed.2016.08.003. Epub 2016 Aug 3.

The influence of prescription opioid use duration and dose on development of treatment resistant depression.

Author information

1
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States. Electronic address: scherrjf@slu.edu.
2
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States.
3
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States.
4
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States.
5
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
6
Saint Louis University Center for Outcomes Research, St. Louis, MO, United States.
7
Center for Applied Health Research, Baylor Scott & White Health, Central Texas Veterans Health Care System, United States; Texas A&M Health Science Center, Bryan, TX, United States; UT Health Science Center, San Antonio, TX, United States.
8
Henry Ford Health System, Center for Health Policy and Health Services Research, Department of Psychiatry, United States.
9
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States; The Bell Street Clinic, VA St. Louis Health Care System - John Cochran Division, St. Louis, MO, United States.

Abstract

Long-term prescription opioid use is associated both with new-onset and recurrence of depression. Whether chronic opioid use interferes with depression management has not been reported, therefore we determined whether patients' longer duration of opioid use and higher opioid dose are associated with new-onset treatment resistant depression (TRD) after controlling for confounding from pain and other variables. Data was obtained from Veteran Health Administration (VHA) de-identified patient medical records. We used a retrospective cohort design from 2000-2012. Eligible subjects (n=6169) were 18-80years of age, free of cancer and HIV, diagnosed with depression and opioid-free for the 24-month interval prior to the observation period. Duration of a new prescription for opioid analgesic was categorized as 1-30days, 31-90days and >90days. Morphine-equivalent dose (MED) during follow-up categorized as ≤50mg versus >50mg per day. Pain and other sources of confounding were controlled by propensity scores and inverse probability of treatment weighting. Cox proportional hazard models were computed to estimate the association between duration and dose of opioid and onset of TRD. After controlling for confounding by weighting data, opioid use for 31-90days and for >90days, compared to 1-30days, was significantly associated with new onset TRD (HR=1.25; 95% CI: 1.09-1.45 and HR=1.52; 95% CI: 1.32-1.74, respectively). MED was not associated with new onset TRD. The risk of developing TRD increased as time spent on opioid analgesics increased. Long-term opioid treatment of chronic pain may interfere with treatment of depression.

KEYWORDS:

Depression; Epidemiology; Opioids; Pain

PMID:
27497660
PMCID:
PMC5050125
DOI:
10.1016/j.ypmed.2016.08.003
[Indexed for MEDLINE]
Free PMC Article

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