title: Prescription opioid analgesics increase the risk of depression.
abstract: BACKGROUND
  Prescription opioid analgesic use has quintupled recently. Evidence linking opioid use with depression emanates from animal models and studies of persons with co-occurring substance use and major depression. Little is known about depressogenic effects of opioid use in other populations.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether prescription opioids are associated with increased risk of diagnosed depression.
  
  
  METHODS
  Retrospective cohort study, new user design.
  
  
  METHODS
  Medical record data from 49,770 US Department of Veterans Affairs (VA) health care system patients with no recent (24-month) history of opioid use or a diagnosis of depression in 1999 and 2000.
  
  
  METHODS
  Propensity scores were used to control for bias by indication, and the data were weighted to balance the distribution of covariates by duration of incident opioid exposure. Cox proportional hazard models with adjustment for painful conditions were used to estimate the association between duration of prescription opioid use and the subsequent risk of development of depression between 2001 and 2007.
  
  
  RESULTS
  Of 49,770 patients who were prescribed an opioid analgesic, 91 % had a prescription for < 90 days, 4 % for 90-180 days, and 5 % for > 180 days. Compared to patients whose prescription was for < 90 days, the risk of depression increased significantly as the duration of opioid prescription increased (HR = 1.25; 95 % CI: 1.05-1.46 for 90-180 days, and HR = 1.51; 95 % CI:1.31-1.74 for > 180 days).
  
  
  CONCLUSIONS
  In this sample of veterans with no recent (24-month) history of depression or opioid analgesic use, the risk of development of depression increased as the duration of opioid analgesic exposure increased. The potential for depressogenic effect should be considered in risk-benefit discussions, and patients initiating opioid treatment should be monitored for development of depression.
authors.affiliation: Research Service, Clinical Research and Epidemiology Workgroup, St. Louis VA Medical Center, St. Louis, MO, USA, scherrjf@slu.edu.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.forename: Dragan M
authors.initials: DM
authors.lastname: Svrakic
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Freedland
authors.forename: Timothy
authors.initials: T
authors.lastname: Chrusciel
authors.forename: Sumitra
authors.initials: S
authors.lastname: Balasubramanian
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Bucholz
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Lawler
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Lustman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects*; D015331:Cohort Studies; D003863:Depression / Q000139:chemically induced* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends; D014728:Veterans / Q000523:psychology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs