Long-Term Opioid Use Promotes Depression Onset

Although opioids can improve mood for a short time, their long-term effects can trigger the onset of depression.

It wasn’t long ago that evidence showed that opioids are less effective in patients with depression and anxiety. Now researchers from Saint Louis University (SLU) found that duration of opioid use has a strong impact on the onset of depression. Published in the Annals of Family Medicine, the findings indicate that opioids, regardless of dosage, contribute to at least one psychiatric condition.

The cohort was gathered from three sets of data totaling 107,755 patients — 70,997 patients from Veterans Health Administration (VHA), 13,777 patients from Baylor Scott & White Health (BSWH), and 22,981 patients from Henry Ford Health System (HFHS). The participants were ages 18 to 80, new opioid users, and no diagnosis of depression at the time of enrollment.

• The MD Magazine Addiction Medicine condition center

Opioid use duration was categorized by one to 30 days, 31 to 90 days, and more than 90 days. Opioid dosage was split by morphine equivalent dose (MED) of one to 50 mg/d, 51 to 100 mg/d, and greater than 100 mg/d. So which patients were most likely to be diagnosed with depression?

Well, interestingly, “Opioid-related new onset of depression is associated with longer duration of use but not dose,” lead author Jeffrey Scherrer, PhD, associate professor in Family and Community Medicine at SLU, said in a news release.

The dosage of opioid analgesic did not really seem to matter that much. However, new onset of depression was increased in those on medication for 31 to 90 days or more than 90 days, when compared to users only on opioids for one to 30 days.

Specifically, 12% of the VHA cohort, 9% of the BSWH cohort, and 11% of the HFHS cohort experienced the new onset of depression. The hazard ratio for 31 to 90 days for VHA and HFHS were 1.18 and 1.33, respectively, and 1.35 and 2.05 for patients on opioids for more than 90 days.

“Findings were remarkably consistent across the three health care systems even though the systems have very different patient characteristics and demographics,” Scherrer explained.

However, since the dosage of opioids did not have a significant influence on depression onset, the findings suggest that even a low dose can affect patients.

“Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression,” Scherrer advised.

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