Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients.
Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients.
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DOI：
10.1016/j.jpain.2015.12.012
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
Lustman PJ
中科院分区：
文献类型：
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作者：
Scherrer JF;Salas J;Copeland LA;Stock EM;Schneider FD;Sullivan M;Bucholz KK;Burroughs T;Lustman PJ
多项研究表明，长期使用阿片类镇痛药与新发抑郁症的风险增加有关。目前尚不清楚抑郁症缓解的患者在接触阿片类镇痛药后是否会增加复发的风险。使用退伍军人健康管理局 (VHA；n=5,400) 和 Baylor Scott & White Health (BSWH；n=842) 的患者数据进行回顾性队列设计，VHA 观察期为 2002-2012 年，BSWH 观察期为 2003-2012 年。符合条件的患者在基线时被诊断为抑郁症，并经历了一段缓解期。抑郁症复发的风险是在缓解前或缓解期间开始使用阿片类药物或未服用阿片类药物处方的患者中建模的。 Cox 比例风险模型测量了阿片类药物使用与控制疼痛和其他混杂因素的抑郁症复发之间的关联。与未接触阿片类药物的患者相比，接触阿片类药物的患者在两个患者群体中抑郁症复发的风险均显着增加（VHA：HR=2.17；95% CI：2.01–2.34；BSWH：HR=1.77；95% CI：1.42–2.21）。这些结果表明，即使在控制了疼痛、精神疾病和阿片类药物滥用之后，阿片类药物的使用也会使抑郁症复发的风险增加一倍。需要进一步的工作来确定风险是否随着使用时间的延长而增加。开始使用阿片类药物后可能需要重复筛查抑郁症。
Several studies have demonstrated chronic opioid analgesic use is associated with increased risk of new onset depression. It is not known if patients with remitted depression are at increased risk of relapse following exposure to opioid analgesics. A retrospective cohort design using patient data from the Veterans Health Administration (VHA; n=5,400), and Baylor Scott & White Health (BSWH; n=842) was performed with an observation period 2002–2012 in VHA and 2003–2012 in BSWH. Eligible patients had a diagnosis of depression at baseline and experienced a period of remission. Risk of depression recurrence was modeled in patients that either started an opioid or remained without opioid prescriptions before or during remission. Cox-proportional hazard models measured the association between opioid use and depression recurrence controlling for pain, and other confounders. Patients exposed to an opioid compared to those unexposed had a significantly greater risk of depression recurrence in both patient populations (VHA: HR=2.17; 95% CI:2.01–2.34; BSWH: HR=1.77; 95% CI:1.42–2.21). These results suggest opioid use doubles the risk of depression recurrence even after controlling for pain, psychiatric disorders and opioid misuse. Further work is needed to determine if risk increases with duration of use. Repeated screening for depression after opioid initiation may be warranted.