Factors associated with the development of depression in chronic non-cancer pain patients following the onset of opioid treatment for pain

Smith, Kimberley J.; Mattick, Richard P.; Bruno, Raimondo; Nielsen, Suzanne; Cohen, Milton; Campbell, Gabrielle; Larance, Briony; Farrell, Michael; Degenhardt, Louisa

doi:10.1016/j.jad.2015.05.049

Cited by 32 publications

(17 citation statements)

References 36 publications

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“…Depression often co-occurs with chronic pain and an emerging line of inquiry is also the association between opiate use and the risk of depression (Scherrer et al, 2014, 2015, 2016; Smith et al, 2015). In particular, the onset of a new depressive state has been associated with longer drug administration (Scherrer et al, 2016).…”

Section: Opiates As Negative Modulators Of Ahngmentioning

confidence: 99%

Opiate Analgesics as Negative Modulators of Adult Hippocampal Neurogenesis: Potential Implications in Clinical Practice

Bortolotto

Grilli

2017

Front. Pharmacol.

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During the past decade, studies of the mechanisms and functional implications of adult hippocampal neurogenesis (ahNG) have significantly progressed. At present, it is proposed that adult born neurons may contribute to a variety of hippocampal-related functions, including specific cognitive aspects and mood regulation. Several groups focussed on the factors that regulate proliferation and fate determination of adult neural stem/progenitor cells (NSC/NPC), including clinically relevant drugs. Opiates were the first drugs shown to negatively impact neurogenesis in the adult mammalian hippocampus. Since that initial report, a vast array of information has been collected on the effect of opiate drugs, by either modulating proliferation of stem/progenitor cells or interfering with differentiation, maturation and survival of adult born neurons. The goal of this review is to critically revise the present state of knowledge on the effect of opiate drugs on the different developmental stages of ahNG, as well as the possible underlying mechanisms. We will also highlight the potential impact of deregulated hippocampal neurogenesis on patients undergoing chronic opiate treatment. Finally, we will discuss the differences in the negative impact on ahNG among clinically relevant opiate drugs, an aspect that may be potentially taken into account to avoid long-term deregulation of neural plasticity and its associated functions in the clinical practice.

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Section: Opiates As Negative Modulators Of Ahngmentioning

confidence: 99%

Opiate Analgesics as Negative Modulators of Adult Hippocampal Neurogenesis: Potential Implications in Clinical Practice

Bortolotto

Grilli

2017

Front. Pharmacol.

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“…Evidence from studies with disparate patient cohorts from U.S. and Australia support the conclusion that prescription opioid analgesic use is associated with risk of new-depression episodes (NDE) (Scherrer et al, 2016a; Scherrer et al, 2016b; Scherrer et al, 2015; Scherrer et al, 2014; Smith et al, 2015). Among Veterans Health Administration (VA) patients who were free of depression and opioids for two years, compared to patients who used opioids for <90 days, the risk of new-onset depression (NDE) increased among patients who used for 91–180 days (HR=1.25; 95% CI, 1.05–1.46) and further increased among patients who used for >180 days (HR=1.51; 95%CI:1.31–1.74)(Scherrer et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of new depression diagnoses in patients with and without prior chronic opioid use

Scherrer

Salas

Schneider

et al. 2017

Journal of Affective Disorders

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Chronic use (>90 Days) of opioid analgesics significantly increases the risk of development of new depression episodes (NDE). It is unclear whether depression that develops in this manner is similar to or different from NDE in persons not exposed to opioid analgesics. METHODS VA patients were classified into two groups, those who did not receive an opioid and developed depression (non-OAU+NDE, n=4,314) and those that had >90 days OAU and developed NDE (OAU+NDE, n=444). OAU+NDE patients were compared to non-OAU+NDE in terms of depression severity (PHQ-9 scores), incidence of PTSD, other anxiety disorders and substance use disorders after NDE, receipt of acute phase antidepressant treatment, dual antidepressant treatment, mood stabilizers and atypical antipsychotics. Prior to computing bivariate analysis, the prevalence of pain conditions and average maximum pain scores were equalized between the two groups using propensity scores and inverse probability of treatment weighting. RESULTS Controlling for pain, OAU+NDE patients had more depression symptoms (p=0.012), more incident PTSD (p=0.04) and opioid abuse/dependence and were more likely to receive 12 weeks of antidepressant treatment (p<0.0001). Last, non-OAU+NDE were more likely to have incident diagnoses for any other anxiety disorder (p=0.014). CONCLUSIONS Within the limitations of electronic medical record data, results indicate OAU+NDE patients have more depression symptoms, greater treatment adherence and different comorbid psychiatric conditions compared to non-OAU+NDE, independent of pain. Overall OAU related depression is as severe as non-OAU related depression and repeated depression screening in chronic opioid therapy may be warranted for pain patients, regardless of pain severity.

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“…More than half had symptoms of moderate to severe depression, previous suicidal thoughts and at least one previous overdose, highlighting that this is a treatment population with considerable complexity. These rates of co‐morbidity are broadly comparable to those seen in other Australian substance use treatment populations . Those with mental health co‐morbidity may be at greater risk of dropping out of treatment , while treating depression may improve pain outcomes .…”

Section: Discussionmentioning

confidence: 52%

Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence

Nielsen

Lintzeris

Murnion

et al. 2018

Drug and Alcohol Review

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Introduction and Aims. Despite large increases in pharmaceutical opioid dependence and related mortality, few studies have focused on the characteristics and treatment experiences of those with pharmaceutical opioid dependence. We describe the formation of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence and describe their baseline characteristics. Design and Methods. People who had entered treatment for pharmaceutical opioid dependence (n = 108) were recruited through drug treatment services in New South Wales, Australia. We describe baseline characteristics of those that commenced pharmaceutical opioids for pain or other reasons and conducted a thematic analysis of responses regarding their treatment experience. Results. Mean age was 41 years (SD 11), half were male (48%). Just over half reported lifetime heroin use (57%). Oxycodone (49%) and codeine (29%) were the most common opioids reported. Most (85%) reported past-year problematic pain, 38% reported chronic pain. Half (52%) reported moderate to severe depression symptoms. Most (66%) commenced opioids for pain, and this group were older, less likely to report a previous overdose and less likely to report use of illicit drugs compared to those commencing for other reasons. Five themes related to treatment expectations: (i) stigma; (ii) the restrictive nature of treatment; (iii) knowledge; (iv) pain; and (v) positive experience with buprenorphine. Discussion and Conclusions. This study describes the complexities in an important emerging treatment population of pharmaceutical opioid-dependent people. Findings highlights that addressing knowledge and perceptions around treatment may be critical to address the rising mortality associated with pharmaceutical opioid dependence. [Nielsen S, Lintzeris N, Murnion B, Degenhardt L, Bruno R, Haber P, Johnson J, Hardy M, Ling S, Saddler C, Dunlop A, Demirkol A, Silsbury C, Phung N, Houseman J, Larance B. Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence. Drug Alcohol Rev 2018;37:887-896]

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Factors associated with the development of depression in chronic non-cancer pain patients following the onset of opioid treatment for pain

Abstract: The findings highlight the importance of monitoring for the emergence of mood dysfunction, particularly for those starting opioids for pain at a younger age, and consideration of psychological treatments that address self-efficacy that appears to be associated with post-opioid depression.

Cited by 32 publications

References 36 publications

Opiate Analgesics as Negative Modulators of Adult Hippocampal Neurogenesis: Potential Implications in Clinical Practice

Opiate Analgesics as Negative Modulators of Adult Hippocampal Neurogenesis: Potential Implications in Clinical Practice

Characteristics of new depression diagnoses in patients with and without prior chronic opioid use

Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence

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