Research paperA longitudinal study of depression among middle-aged and senior patients initiating chronic opioid therapy

•At follow-up, persons with regular/higher-dose opioid use had similar depression scores as those with intermittent/lower dose use, whereas those with minimal/no use had lower depression scores.•Many patients discontinued opioid use due to improved pain. One in five who discontinued opioids cited negative emotional effects as a reason for discontinuation.•Among patients on long-term opioid therapy, differences in depressive symptoms with higher versus lower doses were not evident, but some patients attributed depressive symptoms to opioid use. These patients were more likely to discontinue use.

BackgroundImproved understanding how depressive symptoms change with sustained opioid use is needed.MethodsWe prospectively assessed patients 45 years or older initiating chronic opioid therapy (COT) at baseline and at 4 and 12 months, differentiating recent COT initiators (n=748) and continuing users (n=468). Level of opioid use before 12-month follow-up was classified as regular/higher-dose, intermittent/lower-dose, or minimal/no use. Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8).ResultsDepressive symptoms decreased, on average, from baseline to 12 months regardless of level of opioid use. COT patients with regular/higher-dose compared to those with intermittent/lower-dose opioid use (who had similar pain outcomes) did not differ in PHQ-8 scores at 12 months (adjusted mean difference −0.14, 95% CI, −1.07, 0.78 for COT initiators). At 12 months, COT patients with intermittent/lower-dose use had higher adjusted PHQ-8 scores than did those with minimal/no opioid use (adjusted mean difference 0.77, 95% CI, 0.03-1.52 for COT initiators). However, 77% of patients who discontinued opioids cited improved pain as a reason for discontinuation, while 21% cited negative emotional effects of opioids as a reason for discontinuation. Discontinuation was more common among persons who, at baseline, attributed 3 or more depressive symptoms to opioid use.LimitationsResults are relevant to older COT patients receiving low to moderate opioid doses.ConclusionsDepressive symptoms did not increase with sustained opioid use. Depressive symptoms were not higher with regular/higher-dose compared to intermittent/lower-dose use. Persons who perceived negative effects of opioids on emotions more often discontinued their use.