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A longitudinal study of depression among middle-aged and senior patients initiating chronic opioid therapy.

Abstract：

BACKGROUND:Improved understanding how depressive symptoms change with sustained opioid use is needed. METHODS:We 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). RESULTS:Depressive 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. LIMITATIONS:Results are relevant to older COT patients receiving low to moderate opioid doses. CONCLUSIONS:Depressive 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.

journal_name

J Affect Disord

journal_title

Journal of affective disorders

authors

Von Korff M,Shortreed SM,LeResche L,Saunders K,Thielke S,Thakral M,Rosenberg D,Turner JA

doi

10.1016/j.jad.2016.12.052

subject

Has Abstract

pub_date

2017-03-15 00:00:00

pages

136-143

eissn

0165-0327

issn

1573-2517

pii

S0165-0327(16)31088-6

journal_volume

211

pub_type

杂志文章

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A longitudinal study of depression among middle-aged and senior patients initiating chronic opioid therapy.