Chronic Pain Med Use Increases Depression Incidence

by U.S. Medicine

June 6, 2014
ST. LOUIS – Chronic use of pain-relieving medication can increase in the risk of developing major depression, according to a new veterans study. The study, led by researchers from Saint Louis University and published recently in the Journal of General Internal Medicine, is based on analysis of medical record data from about 50,000 veterans who had no history of opioid use or depression and were subsequently prescribed opioid pain killers.1 Researchers found that patients who started and remained on opioids for 180 days or longer were at a 53% greater risk of developing a new episode of depression. Veterans using opioids for 90-180 days were at a 25% increased risk, compared with patients who never took opioids for longer than 1-89 days. “These findings suggest that the longer one is exposed to opioid analgesics, the greater is their risk of developing depression,” said principal investigator Jeffrey Scherrer, PhD. “Opioids have long been known to allay pain and suffering, but reports of adverse effects are abundant and continue to emerge.” Although there is no clear evidence about how opioids could contribute to the development of depression in a patient, Scherrer suggested there could be several factors that lead to that outcome. Among those, he said, are opioid-induced resetting of the brain’s “reward pathway” to a higher level, which means the chronic use of narcotic pain-killers can elevate the threshold by which humans experience pleasure from natural rewards such as a food or sexual activity. Other factors might include body aches months and years after the use of opioids has stopped, as well as side effects such as adrenal, testosterone and vitamin D deficiencies and glucose dysregulation, Scherrer added. The study, which was funded by the VA HSR&D also suggested that the higher the dose of opioid analgesics, the greater the risk of depression. “Preliminary evidence suggests that, if you can keep your daily dose low, you may be at lower risk for depression,” Scherrer noted. 1Scherrer JF, Svrakic DM, Freedland KE, Chrusciel T, Balasubramanian S, Bucholz KK, Lawler EV, Lustman PJ. Prescription opioid analgesics increase the risk of depression. J Gen Intern Med. 2014 Mar;29(3):491-9. doi: 10.1007/s11606-013-2648-1. Epub 2013 Oct 29. PubMed PMID: 24165926; PubMed Central PMCID: PMC3930792.  

6 Comments

  • Bill Boyer says:

    This study shows a relationship between chronic opiate use and subsequent depression. Rather than assuming that the opiate causes depression it may be that CHRONIC PAIN causes depression. There is extensive literature supporting this.
    Certainly opiates are not routinely depressogenic. There are a number of case reports and case series which attest to the antidepressant properties of these drugs. For hundreds of years opiates had been routinely recommended in the treatment of melancholia, ending only when non-addicting alternatives became available.

  • Bill Boyer says:

    This study shows a relationship between chronic opiate use and subsequent depression. Rather than assuming that the opiate causes depression it may be that CHRONIC PAIN causes depression. There is extensive literature supporting this.
    Certainly opiates are not routinely depressogenic. There are a number of case reports and case series which attest to the antidepressant properties of these drugs. For hundreds of years opiates had been routinely recommended in the treatment of melancholia, ending only when non-addicting alternatives became available.

  • William Boyer, MD says:

    This article implies that chronic opioid use causes depression. There is another, equally possible, interpretation. There is a considerable literature showing that chronic pain causes depression. Therefore chronic opioid use may identify patients who, by virtue of their chronic pain, are at risk of developing depression.

  • Jeffrey Scherrer says:

    As first author, I can defend the argument that opioid exposure at high doses over a long period of time is associated with increased risk of depression after adjusting for the contribution of pain. The methods employed, balancing the pain diagnoses in short and long term opioid users essentially removes pain from the potential contributing factors.

  • William Boyer, MD says:

    This article implies that chronic opioid use causes depression. There is another, equally possible, interpretation. There is a considerable literature showing that chronic pain causes depression. Therefore chronic opioid use may identify patients who, by virtue of their chronic pain, are at risk of developing depression.

  • Jeffrey Scherrer says:

    As first author, I can defend the argument that opioid exposure at high doses over a long period of time is associated with increased risk of depression after adjusting for the contribution of pain. The methods employed, balancing the pain diagnoses in short and long term opioid users essentially removes pain from the potential contributing factors.


Related Articles

Political Issues Related to VA’s Limited Approval of Esketamine for Depression

WASHINGTON—A VA panel this summer opted not to add the new depression medication esketamine, Spravato, to the department’s formulary in the usual way. This came despite strong support from President Donald Trump and an effort... View Article

Debate Continues on Esketamine Efficacy and Safety for Depression Treatment

VA Panel Puts Limits on Use of Drug PHILADELPHIA—Is esketamine a revolutionary treatment for depression or just another moderately effective adjunctive medication with some potentially serious risks? The VA’s Medical Advisory Panel leaned toward the... View Article


U.S. Medicine Recommends


More From pain management

Pain Management

Virtual Reality Tested for Phantom Limb Pain in Veteran Amputees

SAN DIEGO—Virtual reality appears to be a feasible way to treat phantom limb pain at the VA, according to a small new study. The report in Pain Medicine sought To describe the development of a... View Article

Pain Management

VA Researcher Helps Develop Promising New Pain Drug

NEW ORLEANS—A new drug with less risk for addiction and overdose compared to currently available opioid medications is showing promise, according to a recently published research article. The drug, developed at Southeast Louisiana Veterans Health... View Article

Pain Management

Rural Veterans Prescribed More Long-Term Opioids

IOWA CITY, IA—Rural veterans received significantly more opioid prescriptions from the VA than those in urban areas, and that could be behind some of the drug problems in less-populated areas, according to a new study.... View Article

Pain Management

Effectiveness of Topical Pain Creams Questioned in Military Study

BALTIMORE, MD – Extremely high payouts from federal health insurance plans for prescription topical pain creams or gels led Congress to mandate a study on the effectiveness of the products. The new study published in... View Article

Pain Management

Combat Prehospital Analgesia Agents Have Changed in Last Decade

Over time, Tactical Combat Casualty Care) guidelines regarding prehospital analgesia agents have changed, according to a new review.

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up