Chronic Opioid use and Depression
Opioid misuse in self-medicating depression is a growing concern. Even more concerning is the fact that many of these individuals have no history of prior substance abuse. Recent research suggests that depression appears to be a risk factor. As a psychiatrist with years of experience treating depression, over the last decade alone, I can attest that it is extremely rare to see a chronic pain patient who is not depressed or at least doesn’t report symptoms that strongly suggest they are. This points to two types of opioid misusers - those who while having a history of depression were at some point given a prescription for an opiate such as hydrocodone for a new pain complaint, be it acute or chronic in presentation (i.e. motor vehicle accident, post-surgery, a toothache or multiple sclerosis respectively) and those individuals who became depressed while suffering through their pre-existing chronic pain. Nonetheless both groups at some point found some relief from their depression while taking prescription opioids. In a society that embraces the idea of 'more is better ' this can be a slippery and very dangerous slope. As prescription opioids are not FDA approved for depression, there is no guidance or "rule of thumb" on how much is too much when aiming to alleviate depressive symptoms. These individuals are at grave risk of opioid addiction, respiratory depression and even sudden death.
Prescription opioids are the fastest growing form of drug abuse and unintentional overdose. In fact the estimated number of emergency department visits involving non medicinal use of opiate analgesics increased from 144,000 in 2004 to 305,900 in 2008. Prescription opioid misuse as defined by the National Institute for Drug Abuse clearly defines this behavior as "taking a medication in a manner other than that prescribed or for a different condition than that for which the medication was prescribed.” 1 As a medicated society, many Americans see nothing at all wrong or dangerous with holding on to old bottles half full of prescribed pills in their medicine or even kitchen cabinet ( many of you at this point just had a visual of a family member or even your own medicine cabinet) . Even if the pills didn't help the ailment for which they were prescribed this is a common practice in the average American household. Also many of us keep these same prescription bottles (including hydrocodone or other narcotic pain pills) next to other OTC (over-the-counter) bottles of ibuprofen, aspirin and even a daily herbal supplement or multivitamin. This can psychologically give the impression even to most astute that 'these are all equally safe for me and can only help me". Taking pills with the expectation of immediate relief sometimes shuns logic and practicality. Even though opioids are controlled substances with potentially lethal consequences when misused, at that particular moment, the focus is often on feeling better fast with immediate gratification. In the case of taking opioids for depression and pain, one may think "Well if one helped some, then 4 or 5 will do the trick." Again, this is a very dangerous misconception with very grave potential consequences.
FDA approved drugs for depression include classes of medications that increase the reuptake of the major brain chemicals (also known as neurotransmitters) serotonin, dopamine and norepinephrine. SSRIs (selective serotonin re-uptake inhibitors), SNRIs (selective norepinephrine re-uptake inhibitors), DNRIs (dopamine norepinephrine reuptake inhibitors) and tricyclic antidepressants. Many individuals suffering from chronic depression have learned that it normally takes at least two weeks to feel a noticeable difference and often 4 to 6 weeks to experience an appreciable benefit. It is no secret how fast opioids work in treating pain and in some people they also provide a feeling of euphoria. Often psychotherapy can be beneficial in the first few weeks after starting an antidepressant. This is widely accepted as the best approach. Offering comfort, emotional support and reassurance while waiting for the antidepressant to start working. Unfortunately those suffering from depression who do not get immediate relief may resort to various measures often not approved by a health care professional.
Uncontrolled pain can be quite depressing. Chronic pain and unremitting depression often times call for desperate measures. In a country prescribing 123.3 million prescriptions annually of hydrocodone-acetaminophen (generic Vicodin) combined with a societal perception of 'quick - fix remedies' preferable over preventive measures like proper diet, nutrition and exercise, prescription misuse will likely annually increase exponentially unless drastic measures are taken to educate the public. This education will need to include emphasizing the dangers of opioid misuse and how this easily leads to abuse, potential legal ramifications of driving or even working under the influence of narcotics, and the devastation this causes on families; destroying marriages and leaving children emotionally and psychologically distraught. This very devastation is part of the octane that fuels the mission of Ultimaxx Health ....as well as the availability of complementary and integrative options like LEVARE® and Advyndra®.
Executive VP, Ultimaxx Health
Director Mental Health Division