Depression and Substance Abuse | dailyRx

Depression in patients with access to an opioid prescription can lead to misuse through self-medication. Doctors should screen for depression with chronic opioid therapy patients.

A recent study found that patients on chronic opioid therapy who also have depressive symptoms are capable of misusing their opioids.

The patients in the study had no history of substance abuse, but the more serious their depression?the greater the risk of misuse.

Talk to a therapist if you are experiencing depression.

Mark Sullivan, MD, PhD, professor of psychiatry at the University of Washington School of Medicine, and a team of researchers looked into links between depression and opioid misuse in patients who need the to take opioids for pain management.

The Kaiser Permanente health care group of Northern California and the Group Health Cooperative provided the patient data for the study.

Researchers phone interviewed 1,334 patients with chronic opioid therapy (COT) for non-cancer pain. None of the patients had any history of substance abuse.

Each patient was evaluated for depression and asked three questions:

Did they take their opioid for any symptoms other than the physical pain the medication was prescribed for? Did they increase their doses themselves? Did they give or get opioids from others?

Patients who had depressive symptoms were 1.8 to 2.4 times more likely to misuse opioids by taking them for something other than their physical pain.

Patients with depressive symptoms were also 1.9 to 3.1 times more likely to increase their prescribed dosage.

Authors concluded that there was a link between patients who take opioids for COT who also have depressive symptoms and the misuse of opioids.

They suggested that prescribing health care professionals be aware of depressive symptoms as a risk factor for misuse of opioids, even when the patient has no history of substance abuse.?

This study was published in the July/August issue of Annals of Family Medicine. The study was funded by a grant from the National Institute for Drug Abuse, no conflicts of interest were found.
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Depression

Depression impacts an estimated 15 million adults in the United States. Depression is a state of prolonged low mood and aversion to activity. A person's thoughts, behavior, feelings and physical well-being are affected and may include feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, irritability, or restlessness.

The primary treatments for major depression are psychological counseling and medications.

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Medication therapies include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs). SSRIs include: fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). SNRIs include: duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Bupropion (Wellbutrin) is an NDRI. Atypical antidepressants include trazodone (Desyrel) and mirtazapine (Remeron). Each medication category has different side effects.

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Source: http://www.dailyrx.com/news-article/chronic-pain-patients-depressive-symptoms-may-be-risk-substance-misuse-20070.html

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