title: The influence of prescription opioid use duration and dose on development of treatment resistant depression.
abstract: Long-term prescription opioid use is associated both with new-onset and recurrence of depression. Whether chronic opioid use interferes with depression management has not been reported, therefore we determined whether patients' longer duration of opioid use and higher opioid dose are associated with new-onset treatment resistant depression (TRD) after controlling for confounding from pain and other variables. Data was obtained from Veteran Health Administration (VHA) de-identified patient medical records. We used a retrospective cohort design from 2000-2012. Eligible subjects (n=6169) were 18-80years of age, free of cancer and HIV, diagnosed with depression and opioid-free for the 24-month interval prior to the observation period. Duration of a new prescription for opioid analgesic was categorized as 1-30days, 31-90days and >90days. Morphine-equivalent dose (MED) during follow-up categorized as ≤50mg versus >50mg per day. Pain and other sources of confounding were controlled by propensity scores and inverse probability of treatment weighting. Cox proportional hazard models were computed to estimate the association between duration and dose of opioid and onset of TRD. After controlling for confounding by weighting data, opioid use for 31-90days and for >90days, compared to 1-30days, was significantly associated with new onset TRD (HR=1.25; 95% CI: 1.09-1.45 and HR=1.52; 95% CI: 1.32-1.74, respectively). MED was not associated with new onset TRD. The risk of developing TRD increased as time spent on opioid analgesics increased. Long-term opioid treatment of chronic pain may interfere with treatment of depression.
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States. Electronic address: scherrjf@slu.edu.
authors: Jeffrey F
authors: JF
authors: Scherrer
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States.
authors: Joanne
authors: J
authors: Salas
authors: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States.
authors: Mark D
authors: MD
authors: Sullivan
authors: Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States.
authors: F David
authors: FD
authors: Schneider
authors: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
authors: Kathleen K
authors: KK
authors: Bucholz
authors: Saint Louis University Center for Outcomes Research, St. Louis, MO, United States.
authors: Thomas
authors: T
authors: Burroughs
authors: Center for Applied Health Research, Baylor Scott & White Health, Central Texas Veterans Health Care System, United States; Texas A&M Health Science Center, Bryan, TX, United States; UT Health Science Center, San Antonio, TX, United States.
authors: Laurel
authors: L
authors: Copeland
authors: Henry Ford Health System, Center for Health Policy and Health Services Research, Department of Psychiatry, United States.
authors: Brian
authors: B
authors: Ahmedani
authors: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States; The Bell Street Clinic, VA St. Louis Health Care System - John Cochran Division, St. Louis, MO, United States.
authors: Patrick J
authors: PJ
authors: Lustman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000453:epidemiology* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D000701:Analgesics, Opioid
keywords: Depression; Epidemiology; Opioids; Pain