Opioids and Depression

Can opioid abuse influence depression?

Understanding the Connection

Do you know someone with depression? Do you know someone who uses opioids? How about both? Many people who have depression end up abusing opioids. The reverse is also true – many people who are prescribed opioids end up depressed. Are the two related? The answer is yes. We will explain what opioids and depression are and how the two are related.

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What Are Opioids?

Opioid drugs act on the opioid centers of the brain to relieve pain. Natural opioid drugs, called opiates, are derived from the opium poppy. These drugs are considered opiates:

Opium
Morphine
Heroin
Codeine

Synthetic Opioids

Synthetic opioids are opioid drugs that are made either partially or entirely in a lab. These drugs are manufactured as pain relievers by pharmaceutical companies. Synthetic opioids include:¹

Fentanyl
Methadone
Hydrocodone
Oxycodone
Buprenorphine
Tapentadol
Tramadol

What is Depression?

Depression is a mood disorder that results in persistent feelings of sadness and a loss of interest in daily activities. Symptoms include:²

Feelings of sadness or hopelessness
Agitation or anger
Loss of interest or pleasure in activities
Sleep disorders
Changes in appetite
Difficulty focusing or concentrating
Feelings of worthlessness
Physical problems such as headaches with no explained cause
Recurrent thoughts of death or suicide

There are several types of depression, diagnosed based on their severity, how long they last, and their causes. A few include:³

Major Depressive Disorder – Symptoms of depression are present most of the time for two weeks or longer

Persistent Depressive Disorder – Symptoms of depression are present most of the time for two years or longer

Bipolar Disorder – Symptoms of depression alternate with extremely elevated mood and high energy

Psychotic Depression – Symptoms of depression occur along with psychotic symptoms, such as hallucinations, delusions, or paranoia

Situational Depression – of depression occur in response to a stressful life event

Can Opioids Cause Depression?

Research has found a correlation between depression and opioid use. A 2017 study found that 16% of Americans who have mental health disorders, including depression, receive 51.4% of all opioid prescriptions.⁴ Ironically, a 2018 study found that people who screened positive for moderate, moderate-severe, and severe depression were at significantly higher odds of also screening positive for opioid misuse.⁵ Conversely, a 2016 study found that an average of 10% of people prescribed opioids develop a new case of depression after using the opioids for 30 days or longer.⁶

Why Are They Connected?

This could be due to the actions of people with depression themselves, as they may misuse opioids to numb the pain. Having depression is also connected to having lower pain thresholds. This can lead to the prescription of opioid pain killers and may result in increasingly larger doses for opioids to be effective due to tolerance.⁷ Chronic pain, the condition for which the opioids were prescribed, can also lead to depression.

Treating Depression and Opioid Addiction

People who receive treatment for opioid addiction should be screened for depression as well. A 2018 study found that clients who adhered to a regimen of antidepressant medication during treatment for opioid use disorder were more successful at remaining opioid-free than people who did not take antidepressants.⁸

Treatment for opioid addiction should be medically managed. It should include detoxification to remove opioids, medications to manage withdrawal symptoms, and behavioral therapies such as cognitive-behavioral therapy, counseling, and support groups to address addiction’s long-term symptoms. A part of this treatment should address depression. Common treatment includes using antidepressant medication and counseling to address problems at the root of the depression.

People with depression and opioid use disorder should not try to treat themselves. Treatment for these serious conditions should be managed by health professionals who can address these problems safely. If you know someone who has depression and abuses opioids, reach out for help as soon as possible.