Journal of General Internal Medicine

, Volume 29, Issue 3, pp 491–499

Prescription Opioid Analgesics Increase the Risk of Depression

Authors

    • Research Service, Clinical Research and Epidemiology WorkgroupSt. Louis VA Medical Center
    • Department of Family and Community MedicineSaint Louis University School of Medicine
    • Department of PsychiatryWashington University School of Medicine
  • Dragan M. Svrakic
    • Department of PsychiatryWashington University School of Medicine
    • The Bell Street Clinic, John Cochran HospitalSt. Louis VA Medical Center
  • Kenneth E. Freedland
    • Department of PsychiatryWashington University School of Medicine
  • Timothy Chrusciel
    • Research Service, Clinical Research and Epidemiology WorkgroupSt. Louis VA Medical Center
  • Sumitra Balasubramanian
    • Research Service, Clinical Research and Epidemiology WorkgroupSt. Louis VA Medical Center
    • Department of PsychiatryWashington University School of Medicine
  • Kathleen K. Bucholz
    • Department of Family and Community MedicineSaint Louis University School of Medicine
  • Elizabeth V. Lawler
    • Massachusetts Veterans Epidemiology Research and Information Center, VA Cooperative Studies ProgramVA Boston Healthcare System
    • Harvard Medical School and Division of AgingBrigham and Women’s Hospital
  • Patrick J. Lustman
    • Department of PsychiatryWashington University School of Medicine
    • The Bell Street Clinic, John Cochran HospitalSt. Louis VA Medical Center
Original Research

DOI: 10.1007/s11606-013-2648-1

Cite this article as:
Scherrer, J.F., Svrakic, D.M., Freedland, K.E. et al. J GEN INTERN MED (2014) 29: 491. doi:10.1007/s11606-013-2648-1

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 analgesicsdepressionpropensity scoreepidemiologyadministrative medical recordsveteran

Supplementary material

11606_2013_2648_MOESM1_ESM.docx (16 kb)
e-Table 1ICD-9-CM codes used to define diagnoses (DOCX 16 kb)

Copyright information

© Society of General Internal Medicine 2013