Monday, May 15, 2017

How Untreated Depression Contributes to the Opioid Epidemic

It can sometimes seem strange how so much of the country got hooked on opioids within just a few years. Deaths from prescription drugs like oxycodone, hydrocodone, and methadone have more than quadrupled since 1999, according to the CDC. But pain doesn’t seem to be the only culprit: About one-third of Americans have chronic pain, but not all of them take prescription painkillers for it. Of those who do take prescription opioids, not all become addicted.

Several researchers now believe depression, one of the most common medical diagnoses in the U.S., might be one underlying cause that’s driving some patients to seek out prescription opioids and to use them improperly.

People with depression show abnormalities in the body’s release of its own, endogenous, opioid chemicals. Depression tends to exacerbate pain—it makes chronic pain last longer and hurts the recovery process after surgery.

“Depressed people are in a state of alarm,” said Mark Sullivan, a professor of psychiatry at the University of Washington. “They’re fearful, or frozen in place. There’s a heightened sense of threat.” That increased threat sensitivity might also be what heightens sensations of pain.

Not only do people with depression tend to be more pain-sensitive, the effect of opioids can, for some, feel as mood-elevating as an antidepressant.

“Depression is a mixed bag,” Sullivan said. “People can feel sluggish and uninterested, but they can also feel agitated, irritated, and anxious. They feel both unrelaxed and really unmotivated at the same time.”

Opioids might, at least temporarily, feel soothing and sedating. Indeed, several studies have found that buprenorphine, an opioid that is typically used to wean people off of heroin, has some antidepressant properties.

Sullivan and other researchers from Washington and California found in 2012 that depressed people were about twice as likely as non-depressed ones to misuse their painkillers for non-pain symptoms, and depressed individuals were between two and three times more likely to ramp up their own doses of painkillers. Adolescents with depression were also more likely, in one study, to use prescription painkillers for non-medical reasons and to become addicted.

In 2015, a different group of researchers found that depressed people were likely to keep using opioids, even when their pain had subsided and when they were more functional. “If the emotional pain, the depression, is never properly diagnosed or treated, the patient might continue taking the opioid because it’s treating something,” said Jenna Goesling, an assistant professor in the department of anesthesiology at the University of Michigan and an author of that study.

by Olga Khazan, The Atlantic |  Read more:
Image: Jonathan Ernst/Reuters