Department of Family and Community Medicine,Saint Louis University School of Medicine,St. Louis,MissouriandHarry S. Truman Veterans Administration Medical Center,Columbia,Missouri.
Department of Psychiatry and Behavioral Health,University of Washington School of Medicine,Seattle,Washington.
Br J Psychiatry. 2018 Feb;212(2):103-111. doi: 10.1192/bjp.2017.25.
Depression contributes to persistent opioid analgesic use (OAU). Treating depression may increase opioid cessation. Aims To determine if adherence to antidepressant medications (ADMs) v. non-adherence was associated with opioid cessation in patients with a new depression episode after >90 days of OAU.
Patients with non-cancer, non-HIV pain (n = 2821), with a new episode of depression following >90 days of OAU, were eligible if they received ≥1 ADM prescription from 2002 to 2012. ADM adherence was defined as >80% of days covered. Opioid cessation was defined as ≥182 days without a prescription refill. Confounding was controlled by inverse probability of treatment weighting.
In weighted data, the incidence rate of opioid cessation was significantly (P = 0.007) greater in patients who adhered v. did not adhered to taking antidepressants (57.2/1000 v. 45.0/1000 person-years). ADM adherence was significantly associated with opioid cessation (odds ratio (OR) = 1.24, 95% CI 1.05-1.46).
ADM adherence, compared with non-adherence, is associated with opioid cessation in non-cancer pain. Opioid taper and cessation may be more successful when depression is treated to remission. Declaration of interest None.
抑郁会导致持续使用阿片类镇痛药（OAU）。治疗抑郁可能会增加阿片类药物的戒断。目的：确定在接受 OAU 治疗>90 天后出现新的抑郁发作的患者中，与阿片类药物戒断相关的抗抑郁药物（ADM）是否坚持用药与不坚持用药。
患有非癌症、非艾滋病毒疼痛（n=2821）且在 OAU 治疗>90 天后出现新的抑郁发作的患者，如果他们在 2002 年至 2012 年期间接受了≥1 种 ADM 处方，则符合条件。ADM 依从性定义为>80%的天数覆盖。阿片类药物戒断定义为≥182 天没有处方续药。通过逆概率治疗加权来控制混杂因素。
在加权数据中，与不坚持服用抗抑郁药的患者相比，坚持服用抗抑郁药的患者阿片类药物戒断的发生率显著更高（P=0.007）（57.2/1000 与 45.0/1000 人年）。ADM 依从性与阿片类药物戒断显著相关（优势比（OR）=1.24，95%CI 1.05-1.46）。
与不坚持用药相比，ADM 坚持用药与非癌症疼痛患者的阿片类药物戒断相关。当抑郁症治疗到缓解时，阿片类药物的减量和戒断可能会更成功。利益声明：无。
