In patients undergoing rotator cuff repair (RCR), patient comorbidities including mental health diagnoses of anxiety and depression are very common and are known to adversely affect surgical outcomes. This study highlights the complex interplay of mental health with other important considerations in outcomes following RCR, namely opioid use and health care costs. The extent to which we can mitigate opioid use and health care costs in patients with comorbid mental health disorders undergoing RCR remains unclear but worthy of concerted efforts to improve patient outcomes. Improving recognition of the role of mental health comorbidities in outcomes of RCR will be critical in future efforts to improve preoperative counseling and optimize perioperative management of patients electing RCR.