Increased risk of depression recurrence after initiation of prescription opioids in noncancer pain patients

Jeffrey F. Scherrer, Joanne Salas, Laurel A. Copeland, Eileen M. Stock, F. David Schneider, Mark Sullivan, Kathleen K. Bucholz, Thomas Burroughs, Patrick J. Lustman

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Several studies have shown that chronic opioid analgesic use is associated with increased risk of new-onset depression. It is not known if patients with remitted depression are at increased risk of relapse after exposure to opioid analgesics. A retrospective cohort design using patient data from the Veterans Health Administration (VHA; n = 5,400), and Baylor Scott & White Health (BSWH; n = 842) was performed with an observation period in the VHA from 2002 to 2012 and in the BSWH from 2003 to 2012. Eligible patients had a diagnosis of depression at baseline and experienced a period of remission. Risk of depression recurrence was modeled in patients that either started taking an opioid or continued without opioid prescriptions before or during remission. Cox proportional hazard models were used to measure the association between opioid use and depression recurrence controlling for pain, and other confounders. Patients exposed to an opioid compared with those unexposed had a significantly greater risk of depression recurrence in both patient populations (VHA: hazard ratio [HR] = 2.17, 95% confidence interval [CI], 2.01-2.34; BSWH: HR = 1.77; 95% CI, 1.42-2.21). These results suggest opioid use doubles the risk of depression recurrence even after controlling for pain, psychiatric disorders, and opioid misuse. Further work is needed to determine if risk increases with duration of use. Repeated screening for depression after opioid initiation may be warranted. Perspective In 2 large patient cohorts with large differences in demographic characteristics and comorbidity, patients with remitted depression who were exposed to opioid analgesics were 77% to 117% more likely to experience a recurrence of depression than those who remained opioid -free. Routine, not just at initiation of treatment, screening for depression is warranted.

Original languageEnglish (US)
Pages (from-to)473-482
Number of pages10
JournalJournal of Pain
Volume17
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Opioid Analgesics
Prescriptions
Depression
Recurrence
Pain
Confidence Intervals
Veterans Health
United States Department of Veterans Affairs
Somatoform Disorders
Proportional Hazards Models
Psychiatry
Comorbidity
Observation
Demography
Health

Keywords

  • Depression recurrence
  • Epidemiology
  • Opioids
  • Pain
  • Retrospective

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Increased risk of depression recurrence after initiation of prescription opioids in noncancer pain patients. / Scherrer, Jeffrey F.; Salas, Joanne; Copeland, Laurel A.; Stock, Eileen M.; David Schneider, F.; Sullivan, Mark; Bucholz, Kathleen K.; Burroughs, Thomas; Lustman, Patrick J.

In: Journal of Pain, Vol. 17, No. 4, 01.04.2016, p. 473-482.

Research output: Contribution to journalArticle

Scherrer, JF, Salas, J, Copeland, LA, Stock, EM, David Schneider, F, Sullivan, M, Bucholz, KK, Burroughs, T & Lustman, PJ 2016, 'Increased risk of depression recurrence after initiation of prescription opioids in noncancer pain patients', Journal of Pain, vol. 17, no. 4, pp. 473-482. https://doi.org/10.1016/j.jpain.2015.12.012
Scherrer, Jeffrey F. ; Salas, Joanne ; Copeland, Laurel A. ; Stock, Eileen M. ; David Schneider, F. ; Sullivan, Mark ; Bucholz, Kathleen K. ; Burroughs, Thomas ; Lustman, Patrick J. / Increased risk of depression recurrence after initiation of prescription opioids in noncancer pain patients. In: Journal of Pain. 2016 ; Vol. 17, No. 4. pp. 473-482.
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abstract = "Several studies have shown that chronic opioid analgesic use is associated with increased risk of new-onset depression. It is not known if patients with remitted depression are at increased risk of relapse after exposure to opioid analgesics. A retrospective cohort design using patient data from the Veterans Health Administration (VHA; n = 5,400), and Baylor Scott & White Health (BSWH; n = 842) was performed with an observation period in the VHA from 2002 to 2012 and in the BSWH from 2003 to 2012. Eligible patients had a diagnosis of depression at baseline and experienced a period of remission. Risk of depression recurrence was modeled in patients that either started taking an opioid or continued without opioid prescriptions before or during remission. Cox proportional hazard models were used to measure the association between opioid use and depression recurrence controlling for pain, and other confounders. Patients exposed to an opioid compared with those unexposed had a significantly greater risk of depression recurrence in both patient populations (VHA: hazard ratio [HR] = 2.17, 95{\%} confidence interval [CI], 2.01-2.34; BSWH: HR = 1.77; 95{\%} CI, 1.42-2.21). These results suggest opioid use doubles the risk of depression recurrence even after controlling for pain, psychiatric disorders, and opioid misuse. Further work is needed to determine if risk increases with duration of use. Repeated screening for depression after opioid initiation may be warranted. Perspective In 2 large patient cohorts with large differences in demographic characteristics and comorbidity, patients with remitted depression who were exposed to opioid analgesics were 77{\%} to 117{\%} more likely to experience a recurrence of depression than those who remained opioid -free. Routine, not just at initiation of treatment, screening for depression is warranted.",
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