ArticlePain2017
New-onset depression following stable, slow, and rapid rate of prescription opioid dose escalation.
Article in Pain, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
35 citing papers in PubMed, 2 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Mood and Anxiety Symptoms in Persons Taking Prescription Opioids: A Systematic Review with Meta-Analyses of Longitudinal Studies.Pain medicine (Malden, Mass.) · 2022Pooled it
- Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain: A Systematic Review.JAMA network open · 2021Pooled it
- Attenuation of antidepressant and antisuicidal effects of ketamine by opioid receptor antagonism.Molecular psychiatry · 2019Trial
- Risk factors for new-onset anxiety and depression after arthroscopic shoulder stabilization surgery.JSES international · 2026Article
- Analgesic efficacy in women and men with cancer pain, treated with strong opioids: are there differences?BMJ oncology · 2026Article
- Risk of infections among persons treated with opioids for chronic pain: a systematic review and meta-analysis protocol.BMJ open · 2024Article
- The Efficacy of Ketamine for Acute and Chronic Pain in Patients with Cancer: A Systematic Review of Randomized Controlled Trials.Healthcare (Basel, Switzerland) · 2024Review
- Colorectal Cancer Screening Among Individuals With a Substance Use Disorder: A Retrospective Cohort Study.AJPM focus · 2024Article
- Opioid tapering and mental health crisis in older adults.Pharmacoepidemiology and drug safety · 2024Article
- The design and baseline characteristics for the HOPE Consortium Trial to reduce pain and opioid use in hemodialysis.Contemporary clinical trials · 2024Article
- The Complex Association of Daily Opioid Dose with Visits for Pain in Sickle Cell Disease: Tolerance or Treatment-Refractory Pain?Pain medicine (Malden, Mass.) · 2023Observational
- Article
- The Association of Opioid Misuse and Suicidality among People with Disabilities.Substance use & misuse · 2023Article
- Race Differences in Opioid Misuse and Adolescent Suicidality.Child & adolescent social work journal : C & A · 2022Article
- Depression and Long-Term Prescription Opioid Use and Opioid Use Disorder: Implications for Pain Management in Cancer.Current treatment options in oncology · 2022Review
- Approaches to opioid prescribing in cancer survivors: Lessons learned from the general literature.Cancer · 2022Article
- The association of prescription opioid use with suicide attempts: An analysis of statewide medical claims data.PloS one · 2022Article
- Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders: A Multivariable Mendelian Randomization Analysis.JAMA psychiatry · 2021Article
- Opioids in Hemodialysis Patients.Seminars in nephrology · 2021Review
- The Role of the Kappa Opioid System in Comorbid Pain and Psychiatric Disorders: Function and Implications.Frontiers in neuroscience · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 6 institutions in 1 country.
Funding
Abstract
Recent studies suggest that longer durations of opioid use, independent of maximum morphine equivalent dose (MED) achieved, is associated with increased risk of new-onset depression (NOD). Conversely, other studies, not accounting for duration, found that higher MED increased probability of depressive symptoms. To determine whether rate of MED increase is associated with NOD, a retrospective cohort analysis of Veterans Health Administration data (2000-2012) was conducted. Eligible patients were new, chronic (>90 days) opioid users, aged 18 to 80, and without depression diagnoses for 2 years before start of follow-up (n = 7051). Mixed regression models of MED across follow-up defined 4 rate of dose change categories: stable, decrease, slow increase, and rapid increase. Cox proportional hazard models assessed the relationship of rate of dose change and NOD, controlling for pain, duration of use, maximum MED, and other confounders using inverse probability of treatment-weighted propensity scores. Incidence rate for NOD was 14.1/1000PY (person-years) in stable rate, 13.0/1000PY in decreasing, 19.3/1000PY in slow increasing, and 27.5/1000PY in rapid increasing dose. Compared with stable rate, risk of NOD increased incrementally for slow (hazard ratio = 1.22; 95% confidence interval: 1.05-1.42) and rapid (hazard ratio = 1.58; 95% confidence interval: 1.30-1.93) rate of dose increase. Faster rates of MED escalation contribute to NOD, independent of maximum dose, pain, and total opioid duration. Dose escalation may be a proxy for loss of control or undetected abuse known to be associated with depression. Clinicians should avoid rapid dose increase when possible and discuss risk of depression with patients if dose increase is warranted for pain.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.