Jeffrey F Scherrer1, Joanne Salas2, F David Schneider3, Kathleen K Bucholz4, Mark D Sullivan5, Laurel A Copeland6, Brian K Ahmedani7, Thomas Burroughs8, Patrick J Lustman9. 1. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, USA. Electronic address: scherrjf@slu.edu. 2. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, USA. 3. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA. 4. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA. 5. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA. 6. Center for Applied Health Research, Baylor Scott & White Health, Temple, TX, USA; VA Central Western Massachusetts Healthcare System, Leeds, MA and Central Texas Veterans Health Care System, Temple, TX, USA; UT Health Science Center, San Antonio, TX, USA. 7. Henry Ford Health System, Center for Health Policy and Health Services Research and Department of Psychiatry, Detroit, MI, USA. 8. Saint Louis University Center for Outcomes Research, St. Louis, MO, USA. 9. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; The Bell Street Clinic, VA St. Louis Health Care System - John Cochran Division, St. Louis, MO, USA.
Abstract
Chronic use (>90 Days) of opioid analgesics significantly increases the risk of development of new depression episodes (NDE). It is unclear whether depression that develops in this manner is similar to or different from NDE in persons not exposed to opioid analgesic use (OAU). METHODS: VA patients were classified into two groups, those who did not receive an opioid and developed depression (non-OAU+NDE, n=4314) and those that had >90 days OAU and developed NDE (OAU+NDE, n=444). OAU+NDE patients were compared to non-OAU+NDE in terms of depression severity (PHQ-9 scores), incidence of PTSD, other anxiety disorders and substance use disorders after NDE, receipt of acute phase antidepressant treatment, dual antidepressant treatment, mood stabilizers and atypical antipsychotics. Prior to computing bivariate analysis, the prevalence of pain conditions and average maximum pain scores were equalized between the two groups using propensity scores and inverse probability of treatment weighting. RESULTS: Controlling for pain, OAU+NDE patients had more depression symptoms (p=.012), more incident PTSD (p=.04) and opioid abuse/dependence and were more likely to receive 12 weeks of antidepressant treatment (p<.0001). Last, non-OAU+NDE were more likely to have incident diagnoses for any other anxiety disorder (p=.014). CONCLUSIONS: Within the limitations of electronic medical record data, results indicate OAU+NDE patients have more depression symptoms, greater treatment adherence and different comorbid psychiatric conditions compared to non-OAU+NDE, independent of pain. Overall OAU related depression is as severe as non-OAU related depression and repeated depression screening in chronic opioid therapy may be warranted for pain patients, regardless of pain severity.
Chronic use (>90 Days) of opioid analgesics significantly increases the risk of development of new depression episodes (NDE). It is unclear whether depression that develops in this manner is similar to or different from NDE in persons not exposed to opioid analgesic use (OAU). METHODS: VA patients were classified into two groups, those who did not receive an opioid and developed depression (non-OAU+NDE, n=4314) and those that had >90 days OAU and developed NDE (OAU+NDE, n=444). OAU+NDEpatients were compared to non-OAU+NDE in terms of depression severity (PHQ-9 scores), incidence of PTSD, other anxiety disorders and substance use disorders after NDE, receipt of acute phase antidepressant treatment, dual antidepressant treatment, mood stabilizers and atypical antipsychotics. Prior to computing bivariate analysis, the prevalence of pain conditions and average maximum pain scores were equalized between the two groups using propensity scores and inverse probability of treatment weighting. RESULTS: Controlling for pain, OAU+NDEpatients had more depression symptoms (p=.012), more incident PTSD (p=.04) and opioid abuse/dependence and were more likely to receive 12 weeks of antidepressant treatment (p<.0001). Last, non-OAU+NDE were more likely to have incident diagnoses for any other anxiety disorder (p=.014). CONCLUSIONS: Within the limitations of electronic medical record data, results indicate OAU+NDEpatients have more depression symptoms, greater treatment adherence and different comorbid psychiatric conditions compared to non-OAU+NDE, independent of pain. Overall OAU related depression is as severe as non-OAU related depression and repeated depression screening in chronic opioid therapy may be warranted for painpatients, regardless of pain severity.
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