prescription opioids and depression

A recent study examined the association between the use of prescription opioids, depression and anxiety disorders.

In the past two decades the United States has seen a sharp, five-fold increase in opioid prescription use.

Dubbed the “opioid epidemic”, the consequences of this rise have been linked to misuse of the drug, as well as an increase in drug overdoses.

Concern over the rise in chronic use of opioids prompted researchers to investigate the problem. Several studies have linked opioid use with immunosuppression, neurohormonal deficits, and other adverse conditions. Additionally, studies using observational methods have shown a strong link between prescription opioids and depression or anxiety disorders.

While observational studies inform scientists of a potential link, such studies do not employ sufficient control, and as such, cannot provide evidence of directionality or causation. As a result, researchers from the United States and England have conducted a study examining the bidirectional relationship between prescription opioids and depression or anxiety disorders.

As published in JAMA Psychiatry, the researchers used Mendelian randomization, a method looking at genetic material to estimate exposure, thereby overcoming some of the issues with observational studies. Furthermore, as opioids are prescribed for pain, and pain has been connected to both major depressive disorders and anxiety disorders, the researchers included participants who take other pain medications, such as nonsteroidal anti-inflammatory drugs.

Evidence of a link between prescription opioids and depression

The study, with a sample of over 700,000 people, found genetic evidence linking prescription opioids to depression as well as anxiety disorders. Nonopioid analgesics, on the other hand, did not show this link with either disorder. Furthermore, depression, but not anxiety disorders, were shown to be a potential causal link for opioid use, indicating a bidirectional relationship.

The researchers postulate that opioid use results in the dysregulation of the reward circuitry, which in turn, affects the perception of reward, pleasure, or relief regulation. This, potentially, may contribute to the symptoms of major depressive disorder.

Written by Maor Bernshtein

Reference: Rosoff DB, Smith GD, Lohoff FW. Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders: A Multivariable Mendelian Randomization Analysis. JAMA Psychiatry. Published online November 11, 2020. doi:10.1001/jamapsychiatry.2020.3554

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