The Relationship Between Opioids and Depression

opiods, depressionThe world is well aware there is a serious opioid epidemic in the United States. There is also the overwhelming fact that one in 12 adults in the United States suffers with depression.

According to Kathleen Smith, PhD and author of “Depression and Opioid Abuse,” 2.4 million people in the U.S. abuse prescription painkillers and half a million people are addicted to heroin.

Additionally, many of the people who abuse opioids are struggling with depression. If the mental illness goes untreated, it can make recovery that much more difficult.

The relationship between opioid abuse and depression is bi-directional, meaning that suffering from one increases the risk of the other.

Using opioids that are not prescribed, using it longer than prescribed or using more than was prescribed is opioid abuse. The abuse of opioids have been linked to higher rates of depression, anxiety, and bipolar disorders.

The Link Between Depression and Opioids

There is some research that indicates that simply using prescription painkillers can increase the risk of depression. In one study conducted at St. Louis University, scientists discovered that 10 percent of over 100,000 patients prescribed painkillers developed depression after using opioids for more than a month. These patients were taking the medication for ailments such as headaches, back pain, arthritis, and other chronic pain. None of these patients were diagnosed with depression prior to pain treatment.

Many who abuse prescription opioids turn to heroin. It is easily available and costs less. Heroin is a strong opiate. One-fourth of users become addicted to heroin, therefore, the number of people addicted to the drug has doubled in 10 years.

Heroin addiction can lead to feelings of despair, hopelessness, and guilt associated with depression. Researchers estimate that 48 percent of the people addicted to heroin will experience depression. Users are also at in increased risk for suicide. The death by suicide rate among heroin users is 35 percent. For those who have an opioid addiction and depression, treatment should address both conditions, according to Smith.

Opioids cause changes in the brain’s pleasure and reward system and hormone levels. Researchers believe that it is these changes that cause depression. If a person suffers from depression, the opioids are not as effective, possibly leading to an increased use to reach the desired effect. It is recommended that medical professionals screen patients for symptoms of depression before prescribing opioids.

Signs of Depression

  • Lack of interest;
  • Depressed mood or irritability;
  • Changes in sleep;
  • Changes in appetite;
  • Feelings of guilt or despair;
  • Lack of energy;
  • Difficulty concentrating;
  • Suicidal thoughts.

Signs of Opioid Addiction

  • Taking painkillers for longer or in larger amounts than prescribed;
  • Attempted to cut back by was not successful;
  • Spend a lot of time using, obtaining, or recovering from the opioid;
  • Cravings to use the drug;
  • The drug interferes with work, school, or home life;
  • The drug is causing problems in relationships;
  • Using the drug where it is physically hazardous to do so;
  • More of the opioid is necessary to create desired effect.

Effective Treatments for Depression and Opioid Addiction

There are comprehensive treatments available for opioid abuse and depression. There are multiple medications that can treat opioid dependence and several anti-depressants to reduce symptoms of depression. Research indicates that counseling and behavioral support helps the medication become more effective. Many people have better luck with intensive outpatient or impatient treatment to curb addiction and learn health coping strategies for depression.

It is important to first seek treatment to address with withdrawal symptoms of opioids. These symptoms can include nausea, vomiting, stomach pain, sweating, problems sleeping, involuntary movements, nervousness, and intense cravings. Additionally, talk to a doctor about programs that can address the dual diagnoses simultaneously. Effective inpatient and outpatient treatment programs generally include:

  • Peer group support for addiction and depression;
  • Intensive individual counseling;
  • Medication options for opioid replacement and depression;
  • A treatment plan tailored to patient’s individual needs;
  • Onsite medical assistance and support;
  • Family psychoeducation and counseling;
  • Follow-up support.

Anyone taking or considering prescription painkillers should first talk to their doctor about the risks of depression concerning individual mental health history. Non-opioid medications may be an option, and the doctor may also recommend counseling with any pain medication. Those struggling with chronic pain may be at an increased risk for depression whether or not an opioid is taken for the pain.

Depression Drives Overdoses opioids, depression

According to Laura Schwab Reese, an assistant professor of health and kinesiology at Purdue University and lead author of a paper published in Social Psychiatry and Psychiatric Epidemiology:

For every additional 1 percent of the population that has a depression diagnosis, we see between a 25 and 35 percent increase in the number of opioid overdose deaths. We thought maybe suicide was driving this, but we sectioned out unintentional overdose and found that the relationship continued.

In 2017, over 72,000 Americans died of drug overdoses, mostly from opioids. In October 2017, Donald Trump and his administration declared the crisis a public emergency, however, there is still no end in sight. This, combined with the rising rates in depression and the lack of access to mental health care for so many, is proving to be deadly.

The Centers for Disease Control and Prevention analyzed data from 2011 to 2015 that showed the rates of opioid-related deaths were stable from 2011 to 2013, but it has substantially increased in the following two years.

Researchers surveyed 400,000 people over the telephone. They talked to people across the country to gather information on depression. Nineteen percent of respondents reported having a diagnosis of depression in 2015. This is up from 17.5 percent in 2011.

We know from prior literature that people who are depressed are more likely to be prescribed opioids, but also that people who are prescribed opioids are more likely to become depressed. We need to recognize that this is probably a bidirectional relationship, according to Schwab Reese.

She says that solution is twofold. Doctors need to screen for depression and discuss that risk with patients before prescribing opioids. Nearly two-thirds of opioid overdoes involve prescription medications. Doctors could play a large role in preventing the misuse of opioids and depression.

Americans Need Better Access to Mental Health Care

Over 40 million people in the U.S. have a mental health condition and over half of these people do not receive treatment. West Virginia had the highest number of opioid-related deaths in 2015. Nearly one million people live in areas that have a shortage in mental health care providers. In order to meet the mental health needs of all the Americans who need help, the U.S. would need 3,000 more providers, according to another study.

Schwab Reese says that we can’t say this person had depression and that led to an overdose – that was a population-level analysis. To me, that means we need a population-level response.

By Jeanette Smith

Sources:

PSYCOM: Depression and Opioid Abuse
Futurity: DEPRESSION STRONGLY LINKED TO OPIOID-RELATED DEATHS

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