The problem with opioids is that although they may improve your mood short-term, with long-term use there is the risk of a new opioid related depression, according to a recent study.

People with what seems like a substance-induced disorder may actually suffer from a separate mental disorder as well as a substance-induced disorder. Most people suffering from substance addiction may eventually put drugs before their family, friends, jobs and even their children. Various factors including personal expectations, a preexisting mood state, environmental surroundings, and drug dosage must all be considered in trying to understand how a certain patient might experience their substance-induced disorder and this includes opioid related depression.

Researchers at the Henry Ford Health System (HFHS), Baylor Scott & White Health (BSWH), and the Veterans Health Administration (VHA) gathered patient information from 2000 to 2012.

Records from 70,997 patients made up the data sets. Patients were ages 18 to 80, new opioid users who had not been diagnosed with depression prior to taking the medication. The type of opioid drugs in this study included pentazocine, morphine, oxymorphone, oxycodone, meperidine, levorphanol, hydromorphone, hydrocodone, fentanyl, and codeine.

This study was specifically designed to determine:

  1. If taking an opioid medication for a longer time period is linked with new-onset depression even when controlling for dose.
  1. If taking a higher opioid dose is linked with new-onset depression once duration has been adjusted for.
  1. If opioid analgesic use is still linked with new-onset depression once pain scores included in VHA patient data has been controlled for.
  1. If results of the study generalize to two separate healthcare populations.

Results showed that 12% of VHA sample patients, 11% of HFHS sample patients and 9% of BSWH sample patients did experience opioid related depression.

Findings were very consistent across all three healthcare systems although the three systems each have very different demographics and patient characteristics. In all three of the patient populations, taking opioids for analgesic use for a longer duration was linked with opioid related depression once controls were in place for pain and equivalent daily doses of morphine.

The researchers speculated that perhaps an opioid related depression could be explained through long-term opioid use lasting over 30 days, which might lead to low testosterone and changing neuroanatomy. The association was independent of pain, which we know is linked to depression. The study asks clinicians to consider what opioid use may be contributing when a patient develops depression, recognizing that psycho-social stressors and pre-existing mood disorders could also be contributing to both depression and opioid use.

Opioid related depression was linked with a longer usage, but not with dose. Practitioners and patients should know that opioid analgesic use lasting more than 30 days carries the risk of depression.

The authors of the study did note that research on opioids for the treatment of depression, although limited due to small samples, a lack of control groups, and short follow-up times, does not support using opioids for the long-term treatment of depression.

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