Original Research

Journal of General Internal Medicine

, Volume 29, Issue 3, pp 491-499

First online:

Prescription Opioid Analgesics Increase the Risk of Depression

  • Jeffrey F. ScherrerAffiliated withResearch Service, Clinical Research and Epidemiology Workgroup, St. Louis VA Medical CenterDepartment of Family and Community Medicine, Saint Louis University School of MedicineDepartment of Psychiatry, Washington University School of Medicine Email author 
  • , Dragan M. SvrakicAffiliated withDepartment of Psychiatry, Washington University School of MedicineThe Bell Street Clinic, John Cochran Hospital, St. Louis VA Medical Center
  • , Kenneth E. FreedlandAffiliated withDepartment of Psychiatry, Washington University School of Medicine
  • , Timothy ChruscielAffiliated withResearch Service, Clinical Research and Epidemiology Workgroup, St. Louis VA Medical Center
  • , Sumitra BalasubramanianAffiliated withResearch Service, Clinical Research and Epidemiology Workgroup, St. Louis VA Medical CenterDepartment of Psychiatry, Washington University School of Medicine
  • , Kathleen K. BucholzAffiliated withDepartment of Family and Community Medicine, Saint Louis University School of Medicine
  • , Elizabeth V. LawlerAffiliated withMassachusetts Veterans Epidemiology Research and Information Center, VA Cooperative Studies Program, VA Boston Healthcare SystemHarvard Medical School and Division of Aging, Brigham and Women’s Hospital
  • , Patrick J. LustmanAffiliated withDepartment of Psychiatry, Washington University School of MedicineThe Bell Street Clinic, John Cochran Hospital, St. Louis VA Medical Center

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

ABSTRACT

BACKGROUND

Prescription opioid analgesic use has quintupled recently. Evidence linking opioid use with depression emanates from animal models and studies of persons with co-occurring substance use and major depression. Little is known about depressogenic effects of opioid use in other populations.

OBJECTIVE

The purpose of this study was to determine whether prescription opioids are associated with increased risk of diagnosed depression.

DESIGN

Retrospective cohort study, new user design.

PATIENTS

Medical record data from 49,770 US Department of Veterans Affairs (VA) health care system patients with no recent (24-month) history of opioid use or a diagnosis of depression in 1999 and 2000.

MAIN MEASURES

Propensity scores were used to control for bias by indication, and the data were weighted to balance the distribution of covariates by duration of incident opioid exposure. Cox proportional hazard models with adjustment for painful conditions were used to estimate the association between duration of prescription opioid use and the subsequent risk of development of depression between 2001 and 2007.

KEY RESULTS

Of 49,770 patients who were prescribed an opioid analgesic, 91 % had a prescription for < 90 days, 4 % for 90–180 days, and 5 % for > 180 days. Compared to patients whose prescription was for < 90 days, the risk of depression increased significantly as the duration of opioid prescription increased (HR = 1.25; 95 % CI: 1.05–1.46 for 90–180 days, and HR = 1.51; 95  % CI:1.31–1.74 for > 180 days).

CONCLUSIONS

In this sample of veterans with no recent (24-month) history of depression or opioid analgesic use, the risk of development of depression increased as the duration of opioid analgesic exposure increased. The potential for depressogenic effect should be considered in risk-benefit discussions, and patients initiating opioid treatment should be monitored for development of depression.

KEY WORDS

prescription opioid analgesics depression propensity score epidemiology administrative medical records veteran