FROM THE JOURNAL OF AFFECTIVE DISORDERS
Depression combined with chronic opioid analgesic use involves more symptoms and comorbidities than depression without chronic opioid use, according to a study of Department of Veterans Affairs patients seen between 2000 and 2012.
“Screening and treatment of depression in non–cancer pain patients may limit risk of persistent mood disorder and subsequent suicidal ideation,” wrote Jeffrey F. Scherrer, PhD , and his coauthors. “Opioid prescribing for pain management should be coupled with careful screening and treatment of emerging depression.”
The researchers started with 500,000 VA patients and screened electronic health records for patients who visited the VA in the 2 years prior to Jan. 1, 2002 – with no opioid prescriptions or depression diagnoses on those visits – and followed up at least once between 2002 and 2012.
“Eligible patients were cancer free, HIV free. … Because we were interested in characterizing severity of new-onset [new depression episodes] and not predictors of NDE, we measured incident substance use and psychiatric comorbidities that occurred at the same time or after NDE. Therefore, eligible patients were free of psychiatric and substance use disorders before NDE. Patients whose opioid use began after NDE and patients without NDE in follow-up were excluded,” wrote Dr. Scherrer of Saint Louis University and his coauthors ( J Affect Disord. 2017 Mar 1;210:125-9 ).
This process left the researchers with a sample size of 4,758 patients. Of those, 4,314 developed NDE without receiving an opioid, while the remaining 444 developed NDE after opioid use of more than 90 days.
Looking at raw figures prior to the application of inverse probability of treatment weighting (IPTW), the opioid use group was more likely than was the nonopioid use group to have comorbid posttraumatic stress disorder (17.3% vs. 11.9%), opioid (4.3% vs. 0.5%) and other drug abuse/dependence (11.3% vs. 4.8%), all pain-related conditions, obesity (48.2% vs. 37.4%), and nicotine abuse/dependence (52.5% vs. 30.5%). The further calculations were made “to assess whether differences between the groups were irrespective of pain-related variables.”
With IPTW adjustments made, the differences in pain-related comorbidities went away. Opioid-using patients had higher depression severity as measured by Patient Health Questionnaire–9 scores (P = .012). They also were more likely to have had antidepressant treatment for at least 12 weeks (P less than .0001). Nonopioid use patients were more likely to have anxiety disorders other than PTSD (P = .014).
Dr. Scherrer had no conflicts of interest. The study received funding support from the National Institute of Mental Health. The views reflected in the article are those of the authors and not necessarily those of the VA, the researchers reported.
