Opioid cessation in patients with non-cancer pain may be more successful when depression is treated to remission, according to a study published in the February 2018 issue of the British Journal of Psychiatry.
The study found that patients with chronic prescription opioid use and depression who adhered to antidepressant medications were more likely to stop opioids.
Exploratory analysis found that patients who adhered to anti-depression medications and stopped taking opioids experienced a rapid and greater decline in depression symptoms compared with patients who did not stop taking opioids.
“We can’t be sure that a decrease in depression led to patients’ choosing to stop opioid use and we know prospective studies are needed,” said Jeffrey Scherrer, PhD, Saint Louis University, St. Louis, Missouri. “Depression can worsen pain and is common in patients who remain long-term prescription opioid users. Our study should encourage clinicians to determine if their non-cancer pain patients are suffering from depression and aggressively treat patients’ depression to reduce opioid use.”
The researchers used a retrospective cohort design to compare adherence to antidepressants versus non-adherence in patients with chronic non-cancer pain who were 90 day-plus prescription opioid users. Previous studies have shown the odds of depression improvement are markedly greater in patients who adhere to anti-depressants.
Using data from the Veterans Health Administration, a random sample of 500,000 patients was taken from a cohort of 2,910,335 identified with at least 1 outpatient visit in both fiscal years 1999 and 2000. The patients were aged 18 to 80 years and excluded patients with an HIV or cancer diagnosis. Patients must have had at least 1 yearly visit between 2000 and 2001 during which they must have been free of a medical record depression diagnosis. All patients developed depression following more than 90 days of continuous prescription opioid use.
Between 1.4% and 10% of patients with a new opioid prescription develop chronic opioid analgesic use and a majority (65%-80%) of patients who had persistent opioid analgesic use for 90 days were still taking opioids 3 to 5 years later.
These long-term patients were more likely than those that use opioids for a shorter amount of time to develop opioid disorder and overdose.
Chronic analgesic use was also associated with new depressive episodes and treatment-resistant depression.
“Effective depression treatment may break the mutually reinforcing opioid-depression relationship and increase the likelihood of successful opioid cessation,” said Dr. Scherrer.