Impact of adherence to antidepressants on long-term prescription opioid use cessation

Br J Psychiatry. 2018 Feb;212(2):103-111. doi: 10.1192/bjp.2017.25.


Background: 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.

Method: 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.

Results: 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).

Conclusions: 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage*
  • Antidepressive Agents / administration & dosage*
  • Comorbidity
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / epidemiology
  • Female
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Pain / drug therapy*
  • Pain / epidemiology
  • Retrospective Studies
  • Young Adult


  • Analgesics, Opioid
  • Antidepressive Agents