Blog | Tuesday, February 25, 2014

QD: News Every Day--Taking opioid analgesics for longer spans may lead to depression

The risk of development of depression may increase when patients are on opioid analgesics longer, a study found

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 depressive effects of opioid use in other populations.

Researchers conducted a retrospective cohort study based on medical records of nearly 50,000 VA patients without a history of opioid use or a diagnosis of depression within the previous two years.

Results appeared in the March issue of the Journal of General Internal Medicine.

The incidence of depression for the entire cohort was 6.4 %. Patients taking opioids for longer than 180 days had a shorter time to a depression diagnosis compared to patients taking them for 90 to 180 days and 1 to 89 days. The incidence of depression was 17.7/1,000 patient years for those taking them 1 to 89 days, 23.8/1,000 patient years among patients taking them for 90 to 180 days, and 27.8/1,000 patient years for those taking them more than 180 days.

Compared to patients whose prescription was for less than 90 days, the risk of depression increased significantly as the duration of opioid prescription increased (prescription 90 to 180 days: HR=1.25; 95 % CI, 1.05 to 1.46; prescription more than 180 days: HR=1.51; 95 % CI, 1.31 to 1.74).

Researchers suggested that patients starting opioid treatment should be monitored for depression, since an opioid-associated risk of depression was revealed in a population at low risk of depression given their advanced age and having no recent history of it in the previous 24 months, They suggested that some depression may have been avoided had opioid therapy not been started or limited to less than 90 days.

Authors wrote, “The term ‘Pharmageddon’ was coined to capture the epidemic nature and adverse public health consequences of opioid analgesics. Our findings add to such concerns by showing that opioid use for more than 90 days significantly increases the risk of developing depression.”