Wednesday, February 14, 2018

Antidepressants May Reduce Opioid Use in Patients With Comorbid Depression, Chronic Pain

Patients experiencing chronic pain and depression may be more likely to stop taking opioids if they adhere to their antidepressants, reports a study published in the British Journal of Psychiatry. Further analysis also suggests that halting opioid use contributes to improvements in depression.

“Depression can worsen pain and is common in patients who remain long-term prescription opioid users,” Jeffrey Scherrer, Ph.D., of the Saint Louis University School of Medicine said in a press release. “Effective depression treatment may break the mutually reinforcing opioid-depression relationship and increase the likelihood of successful opioid cessation.”

Scherrer and colleagues analyzed electronic medical records from the Veterans Health Administration for this study. They identified 2,821 patients who received antidepressants for a new diagnosis of depression following at least 90 days of opioid use for chronic pain (excluding cancer pain or HIV pain). Of this group, 1,077 of the patients were adherent to antidepressants (took at least 80% of their prescribed amount) and 1,744 were not.

The authors calculated that antidepressant adherence was associated with a 24% greater likelihood of opioid cessation; this association was not related to duration of opioid use, degree of pain, or number of other medical comorbidities.

An exploratory analysis of all four patient subgroups (adherent/nonadherent and opioid cessation/noncessation) revealed that patients who stopped using opioids—regardless of their adherence—showed greater improvements in their depressive symptoms. However, antidepressant adherent patients who stopped using opioids showed the greatest improvements.

While the authors cautioned more studies are needed to confirm these preliminary findings, they wrote “together, these results provide preliminary evidence that a reduction in depression may lead to OAU [opioid analgesic use] cessation … opioid taper paired with antidepressant medications could result in a faster reduction of depression symptoms and increase the likelihood of successful OAU cessation.”

To read more on this topic, see the Psychiatric News article “Many Prescription Opioids Go to Adults With Depression, Anxiety.”

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