Depression risk increases with long-term use of codeine and other opioids

Depression risk increases with long-term use of codeine and other opioidsA recent study conducted by researchers at the Saint Louis University, reveals that while opioids help elevate moods in the short term, prolonged usage could lead to new-onset depression. The study is published online in the Jan 11 edition of Annals of Family Medicine, under the heading “Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations.”

For the study, a team of researchers, led by Jeffrey Scherrer, Ph.D., associate professor for family and community medicine at Saint Louis University, collected data of 107,755 patients between 2000 and 2012.


All the patients were new opioid users, ages 18 to 80, and none of them had a history of depression when they started off on the opioid medication. The opioid drugs used by the patients included codeine, oxycodone, hydrocodone, morphine, oxymorphone, hydromorphone, levorphanol, meperidine, fentanyl, and pentazocine.

Of the 107,755 patients, 70,997 patients were from the Veterans Health Administration (VHA), 13,777 patients were from Baylor Scott & White Health (BSWH), and the remaining 22,981 patients were from the Henry Ford Health System (HFHS).

Even though the three different health care systems have varied patient characteristics and demographics, the numbers were remarkably consistent across the three health care systems. In all three patient populations, longer duration of opioid analgesics showed an increase in new-onset depression.
To be more specific, the researchers found that 12% of the patients from VHA, 9% of the patients from BSWH, and 11% of the patients from HFHS developed new-onset depression after using opioid for analgesic purposes.

It is important for clinicians to note that the link is independent of the known contribution of pain to depression. It’s equally important to note that opioid-related new onset of depression is associated with longer duration of use, but not dose.

The team explains that using opioids for more than 30 days leads to changes in anatomy of the nervous system, causes a drop in testosterone levels, and also lead to other possible biological changes.

According to Dr. Scherrer, patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression.”

The study calls for more detailed research to figure out what makes certain patients more vulnerable to opioid-related depression, and to identify these patients before opioid-related depression sets in.


Though the study is limited by small sample sizes, lack of control groups, and limited follow up times, there is enough evidence in the study for the team to vote against opioids as an effective long-term treatment for depression.

Also read: Depression health news roundup 2015: Depression prevention and treatment breakthroughs


Author Bio

Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.