Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Opioid Therapy: No Increase in Depressive Symptoms

J Affect Disord; ePub 2017 Jan 6; Von Korff, et al

Depressive symptoms among middle-aged and senior patients did not increase with sustained opioid use, a recent study found. Researchers prospectively assessed patients aged ≥45 years initiating chronic opioid therapy (COT) at baseline and at 4 and 12 months, differentiating recent COT initiators (n=748) and continuing users (n=468). Level of opioid use before 12-month follow-up was classified as regular/higher-dose, intermittent/lower-dose, or minimal/no use. Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8). They found:

  • Depressive symptoms decreased, on average, from baseline to 12 months regardless of level of opioid use.
  • COT patients with regular/higher-dose compared to those with intermittent/lower-dose opioid use (who had similar pain outcomes) did not differ in PHQ-8 scores at 12 months.
  • At 12 months, COT patients with intermittent/lower-dose use had higher adjusted PHQ-8 scores than did those with minimal/no opioid use.
  • However, 77% of patients who discontinued opioids cited improved pain as a reason for discontinuation, while 21% cited negative emotional effects of opioids as a reason for discontinuation.

Citation:

Von Korff M, Shortreed SM, LeResche L, et al. A longitudinal study of depression among middle-aged and senior patients initiating chronic opioid therapy. [Published online ahead of print January 6, 2017]. J Affect Disord. doi:10.1016/j.jad.2016.12.052.