By Stephanie Thomas
Each day, news reports shed more light on the depth and breadth of our nation’s opioid crisis. Still, we have so much to learn about the reasons behind the current crisis. But some new research may help to enhance our understanding of this specific addiction — namely, that folks dealing with depression make up a significant portion of opioid-prescribed patients.
With this knowledge, we can move forward to address a root of the problem — depression itself — in our hope to reduce opioid addiction in the years to come.
Opioid Fatalities on the Rise
More than 2 million Americans rely on opioids to get through the day.1 In 2016, prescription opioids caused 14,400 deaths. Heroin, which is often the next logical step in the progression of opioid misuse, was found present in 15,400 overdose cases. And with the growing addition of fentanyl — a potent and easily lethal drug — users are expected to continue experiencing overdoses at alarming rates.2
Recent Research on Depression and Opioid Use
When it comes to written prescriptions for opioids, half are given to patients with mental health disorders, a population making up just 16 percent of our country.3 This fact alone should give us pause about how mental health and prescription approaches intersect.
New studies also reveal other disturbing trends:
- Opioids work to combat intense physical pain. And yet we see them increasingly prescribed to patients with anxiety, depression and mood disorders.4
- People with depression misuse painkillers at twice the rate of non-depressed individuals.5
- People with depression do not follow a typical pattern of opioid misuse, where dosages are self-increased as pain goes up. Pain seems to have no bearing on misuse.6
These statistics ring true for patients with depression who have no history of substance abuse.7
Why Is a Person With Depression Prescribed Opioids?
Depression as a medical condition often goes unnoticed, and thus untreated, by primary care doctors.5 This reality contributes to opioid misuse among people with depression for three key reasons:
- Depression carries stigma. When a patient talks with her doctor, she may be embarrassed to describe her symptoms fully. As psychiatry professor Mark Sullivan says, “It’s easier to explain not being able to get out of bed because of a bad back than crushing sadness.”5
- Depression intensifies pain. While a fear of stigma may cause patients to leave depression out of the discussion, the pain is no less real. In fact, you could say depression makes physical pain more real, causing some patients with depression to report pain that would be considered mild by the average person as unbearable.8
- Opioids elevate a person’s mood. For people dealing with depression and chronic pain, any relief feels welcome. So when a doctor prescribes opioids, which have some antidepressant similarities, a patient may experience a temporary calming. And why stop drug use if, after all, life now seems better — even just marginally so.5
The Impact of Opioid Use on a Person Dealing With Depression
The hope of any medical or mental health treatment plan should be to reach a place where medicine is no longer needed. Taking opioids while depressed almost certainly ensures the opposite. Studies show that depression causes people to avoid weaning themselves off opioids and instead makes them twice as likely to use opioids on a more long-term basis.5
Beyond the obvious risks of addiction for people fighting depression, long-term opioid use simply doesn’t help the mental health symptoms in any sustainable way:
- Opioids heighten depression. After just one month of prescription opioid use, patients face an increased risk of depression.9 Naturally, they’ll attempt to combat lower levels of life satisfaction with higher doses of opioids, which may, in turn, bring more depression.
- Opioids magnify pain. Because opioids essentially tell the brain a person is not hurting when he is, years of opioid use require the body to send stronger and stronger signals to the brain, resulting in hypersensitivity and a body that no longer responds to medication.8
Alternatives to Opioids for Fighting the Pain of Depression
It seems the key to conquering depression — and the chronic pain that often comes with it — is to consider every symptom and treat all problems equally. One study found that by addressing depression specifically, patients were able to stop using opioids altogether, a huge win when nothing else worked.10
Of course, our hope is that, with a well-rounded support group and comprehensive mental health treatment, people dealing with depression can avoid opioids altogether. The best bet for making this happen is to build a team you trust:
- Find a doctor who will prescribe the right antidepressant for you to decrease both depression and11
- Find a physical therapist who will help you rebuild physical strength and take advantage of mood-boosting endorphins.8
- Find a talk therapist who will help you assess your past and make practical plans for the future.8
If you or a loved one is dealing with depression and would like help building your support team, give us a call. Our admissions coordinators can help answer your questions about your treatment options.
1 Katz, Josh. “Drug Deaths in America Are Rising Faster Than Ever.” The New York Times, June 5, 2017.
2 Katz, Josh. “The First Count of Fentanyl Deaths in 2016: Up 540% in Three Years.” The New York Times, September 2, 2017.
3 Davis, MA. “Prescription Opioid Use Among Adults With Mental Health Disorders in the United States.” Journal of the American Board of Family Medicine, August 2017.
4 Caruso, Catherine. “51 Percent of Opioid Prescriptions Go to People With Depression and Other Mood Disorders.” Stat News, June 26, 2017.
5 Khazan, Olga. “How Untreated Depression Contributes to the Opioid Epidemic.” The Atlantic, May 15, 2017.
6 Goesling, J. “Symptoms of Depression Are Associated With Opioid Use Regardless of Pain Severity and Physical Functioning Among Treatment-Seeking Patients With Chronic Pain.” The Journal of Pain, June 12, 2015.
7 Grattan, Alicia. “Depression and Prescription Opioid Misuse Among Chronic Opioid Therapy Recipients With No History of Substance Abuse.” Annals of Family Medicine, July 2012.
8 Bernstein, Lenny. “Greater Opioid Use and Mental Health Disorders Are Linked in a New Study.” The Washington Post, June 26, 2017.
9 Scherrer, Jeffrey. “Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations.” Annals of Family Medicine, October 19, 2015.
10 Avery, Topher. “Study: Depression Treatment Bolsters Opioid Recovery.” Inpatientrehabillinois.com, August 12, 2018.
11 “Depression and Chronic Pain.” Web MD, October 7, 2016.