Chronic use of painkillers may lead to depression

Long-term use of prescription-based painkillers can increase the risk of depression, a new study has found.
Opioid analgesics, or prescription-based narcotic pain killers, have long been known to reduce pain, but reports of adverse effects and addiction continue to surface.
Now, a team of investigators led by a Saint Louis University researcher has discovered a link between chronic use of pain-relieving medication and increase in the risk of developing major depression.
The study analysed medical record data of about 50,000 veterans who had no history of opioid use or depression, and were subsequently prescribed opioid pain killers.
Patients who started and remained on opioids for 180 days or longer were at a 53 per cent increased risk of developing a new episode of depression, and those using opioids for 90-180 days were at a 25 per cent increased risk compared to patients who never took opioids for longer than 1-89 days.

"These findings suggest that the longer one is exposed to opioid analgesics, the greater is their risk of developing depression," said Jeffrey Scherrer, principal investigator of the study.

"Opioids have long been known to allay pain and suffering, but reports of adverse effects are abundant and continue to emerge," said Scherrer.
Scherrer said even though there is no clear evidence about the mechanisms by which opioids may contribute to the development of depression in a patient, there could be several factors that lead to it.
Some of these include opioid-induced resetting of the brain's "reward pathway" to a higher level, which means the chronic use of narcotic pain killers can elevate the threshold for a person's ability to experience pleasure from natural rewards such as a food or sexual activity.

Other factors may include body aches months and years after the use of opioids has stopped, side effects such as adrenal, testosterone and vitamin D deficiencies and glucose dysregulation.
The study also suggests that the higher the dose of opioid analgesics, the greater the risk of depression.
"Preliminary evidence suggests that if you can keep your daily dose low, you may be at lower risk for depression," Scherrer said.
The study was published in the Journal of General Internal Medicine.