High Opioid Doses Linked to Depression

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opiates and depressionIncreasing your opioid painkiller dose may cause you to feel more depressed, according to a new study published in Pain, the journal for the International Association for the Study of Pain.

Chronic pain is a serious issue for at least 100 million Americans, according to the American Academy of Pain Medicine. Many people who suffer chronic pain rely on opioids, powerful analgesics with a chemical structure similar to the morphine derived from the opium poppy plant. Opioids are effective for relieving many different types of chronic pain.

Many types of chronic pain problems are common in those with anxiety disorders, according to the Anxiety and Depression Association of America. In fact, about 77 percent of patients with chronic pain report feeling depressed. This recent study highlights the association between chronic pain and anxiety disorders, especially the effects of raising opioid doses.

The Study

In the study, published in February of 2015, researchers issued questionnaires to 355 back pain patients at three different times: once as a baseline, at the one-year mark, and again at two years. The survey asked about the participants’ pain, depression, anxiety, stress, and quality of life as it pertains to health. The scientists also reviewed the participants’ charts to gather information about any co-existing conditions the patients may have had, as well as data about the type and dose of opioids the subjects used.

Some opioids are stronger than are others. To make it easier to discuss the relative strength of one opioid to another, scientists have created a system of comparing the strength of each opioid to morphine, known as the morphine equivalent dose (MED). A low MED provides only the smallest amount of pain relief as compared to a stronger dose with a high MED.  The scientists grouped MED doses and dose changes into three categories, measured in milligrams: 0 mg, 1 – 50 mg, and greater than 50 mg.

The researchers used a variety of statistical models to estimate the association between the MED dose and the probability of depression over time. The investigators also looked at the association between a change in depression and the odds of increasing opioid dose over time.

The scientists found that a dose increase greater than the morphine equivalent of 50 mg increased a participant’s probability over time. Dose increases of 1 to 50 mg MED did not seem to increase the participant’s likelihood of depression with time.

The study strongly suggests that changing to a stronger dose increases the risk for depression and that depression raises the risk for greater MED. The scientists concluded by speculating that treating depression or lowering doses may reduce the risk for the two-way association between opioids and depression and may ultimately improve how doctors manage pain.

Long-term use of opioids, especially at higher doses, also increases the risk for side effects. Opioid dependence and addiction are more likely to occur with extended use at high doses. Addiction and dependence make it more difficult to lower doses as needed, as the individual will experience withdrawal symptoms and cravings with lowered doses. Withdrawal and cravings associated with long-term use and high doses can make quitting opioids difficult too, especially for people who also struggle with depression and other anxiety disorders.

If you would like to quit opioids but have been taking them for a long time and suffer from depression, contact the Waismann Method ® Rapid Detox Center today. Our caring professionals are always here to help.