Scherrer Jeffrey F, Salas Joanne, Schneider F David, Bucholz Kathleen K, Sullivan Mark D, Copeland Laurel A, Ahmedani Brian K, Burroughs Thomas, Lustman Patrick J
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, USA.
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, USA.
J Affect Disord. 2017 Mar 1;210:125-129. doi: 10.1016/j.jad.2016.12.027. Epub 2016 Dec 21.
Chronic use (>90 Days) of opioid analgesics significantly increases the risk of development of new depression episodes (NDE). It is unclear whether depression that develops in this manner is similar to or different from NDE in persons not exposed to opioid analgesic use (OAU).
VA patients were classified into two groups, those who did not receive an opioid and developed depression (non-OAU+NDE, n=4314) and those that had >90 days OAU and developed NDE (OAU+NDE, n=444). OAU+NDE patients were compared to non-OAU+NDE in terms of depression severity (PHQ-9 scores), incidence of PTSD, other anxiety disorders and substance use disorders after NDE, receipt of acute phase antidepressant treatment, dual antidepressant treatment, mood stabilizers and atypical antipsychotics. Prior to computing bivariate analysis, the prevalence of pain conditions and average maximum pain scores were equalized between the two groups using propensity scores and inverse probability of treatment weighting.
Controlling for pain, OAU+NDE patients had more depression symptoms (p=.012), more incident PTSD (p=.04) and opioid abuse/dependence and were more likely to receive 12 weeks of antidepressant treatment (p<.0001). Last, non-OAU+NDE were more likely to have incident diagnoses for any other anxiety disorder (p=.014).
Within the limitations of electronic medical record data, results indicate OAU+NDE patients have more depression symptoms, greater treatment adherence and different comorbid psychiatric conditions compared to non-OAU+NDE, independent of pain. Overall OAU related depression is as severe as non-OAU related depression and repeated depression screening in chronic opioid therapy may be warranted for pain patients, regardless of pain severity.
长期（>90天）使用阿片类镇痛药会显著增加新发抑郁发作（NDE）的风险。尚不清楚以这种方式发生的抑郁症与未使用阿片类镇痛药（OAU）的人群中的NDE是否相似或不同。
退伍军人事务部（VA）的患者被分为两组，即未接受阿片类药物且患抑郁症的患者（非OAU + NDE，n = 4314）和OAU超过90天且患NDE的患者（OAU + NDE，n = 444）。在抑郁严重程度（PHQ - 9评分）、创伤后应激障碍（PTSD）发病率、NDE后其他焦虑症和物质使用障碍、接受急性期抗抑郁治疗、双重抗抑郁治疗、情绪稳定剂和非典型抗精神病药物方面，对OAU + NDE患者与非OAU + NDE患者进行了比较。在进行双变量分析之前，使用倾向评分和治疗权重的逆概率使两组之间的疼痛状况患病率和平均最大疼痛评分相等。
在控制疼痛的情况下，OAU + NDE患者有更多的抑郁症状（p = 0.012）、更多的新发PTSD（p = 0.04）和阿片类药物滥用/依赖，并且更有可能接受12周的抗抑郁治疗（p < 0.0001）。最后，非OAU + NDE患者更有可能被诊断出患有任何其他焦虑症（p = 0.014）。
在电子病历数据的局限性范围内，结果表明与非OAU + NDE相比，OAU + NDE患者有更多的抑郁症状、更高的治疗依从性和不同的共病精神疾病状况，与疼痛无关。总体而言，与OAU相关的抑郁症与与非OAU相关的抑郁症一样严重，对于疼痛患者，无论疼痛严重程度如何，在慢性阿片类药物治疗中进行反复的抑郁筛查可能是必要的。
