Risk of Depression Increased by Long-Term Use of Prescription Painkillers

By Dr. Mercola

If you take prescription narcotic painkillers known as opioids for 90 days or more, you may significantly raise your risk of developing major depression, according to new research that adds to growing concerns surrounding the use of these common medications.

While those who took the drugs for 90 to 180 days had a 25 percent increased risk of depression, those who took opioids for 180 days or longer were at a 53 percent increased risk of developing depression compared to those who did not.¹

In other words, the risk seemed to go up the longer the painkillers were used, and also went up as the dosage increased. The researchers concluded:

"…the risk of development of depression increased as the duration of opioid analgesic exposure increased."

Why Might Prescription Painkillers Lead to Depression?

It's not entirely clear how the drugs may be involved in depression, although it is widely known that they have a strong impact on your brain. The drugs work by binding to receptors in your brain to decrease the perception of pain.

But they also create a temporary feeling of euphoria followed by dysphoria that can easily lead to physical dependence and addiction. The researchers speculated that there could be numerous factors linking opioid painkillers with depression:

"Some of these include opioid-induced resetting of the brain's 'reward pathway' to a higher level, which means the chronic use of narcotic pain killers can elevate the threshold for a person's ability to experience pleasure from natural rewards such as a food or sexual activity.

Other factors may include body aches months and years after the use of opioids has stopped, side effects such as adrenal, testosterone and vitamin D deficiencies and glucose dysregulation."²

Use of Prescription Opioid Painkillers Has Quintupled

The study's lead author shared the startling statistics that "the use of prescription opioid analgesics has quintupled recently and that more than 200 million prescriptions were issued to patients in 2009 in the US."³

Given the magnitude of their use, their link to depression could constitute a "public health problem," he said.

It wouldn't be the first time the drugs have been linked to health problems of epidemic proportions. Prescription drug abuse has been called the fastest-growing drug problem in the US by the Centers for Disease Control and Prevention (CDC), as the number of deaths from opioid painkillers like hydrocodone and oxycodone rose nearly four-fold between 1999 and 2009.

Men are still more likely to die from prescription painkiller overdose, but women are quickly catching up. Nearly 50,000 such deaths occurred among women between 1999 and 2010, and the statistics revealed by the CDC give a somber view of this growing problem:⁴

• More than 6,600 women, or 18 women every day, died from a prescription painkiller overdose in 2010
• There were four times more deaths among women from prescription painkiller overdose than for cocaine and heroin deaths combined in 2010.
• In 2010, there were more than 200,000 emergency department visits for opioid misuse or abuse among women -- about one every three minutes.

The problem, once primarily seen in inner cities, is now even spanning to rural areas, hitting people of all ethnic backgrounds and income levels.

Opioids Are Among the Most Commonly Abused Drugs

Opioids like morphine, codeine, oxycodone, hydrocodone and fentanyl are one of the most commonly abused drug classes. These drugs are not only addictive, they can lead to slowed breathing and death if too much is taken, and the risks are compounded if you add alcohol to the equation.

Hydrocodone, a prescription opiate, is synthetic heroin. It's indistinguishable from any other heroin as far as your brain and body is concerned. So, if you're hooked on hydrocodone, you are in fact a good-old-fashioned heroin addict.

Worse, pain-killing drugs like fentanyl are actually 100 times more potent than natural opioids like morphine, making the addictive potential and side effects associated with prescription drug use much higher. At the root of the problem, of course, is the fact that so many Americans are struggling with pain.

Chronic pain affects 100 million Americans – that's more than the number impacted by diabetes, heart disease and cancer combined. Yet, many physicians simply do not know how to help their patients manage, or eliminate, chronic pain without the use of these risky drugs.

The 'Pain Prescription' That Won't Increase Your Risk of Depression (or Any Other Chronic Disease!)

If you suffer from chronic pain, prescription medications should be your last resort. Rarely, if ever, should they be your go-to option. If your physician has not spoken with you about some of these natural methods to address pain at its most foundational level, it may be time to seek out one who will. The four steps I recommend doing first, include:

• Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief.
• Reduce your intake of most processed foods as not only do they contain sugar and additives but most are loaded with omega-6 fats that upset your delicate omega-3:omega-6 ratio, which will contribute to inflammation, a key factor in most pain.
• Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
• Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.

Try These 5 Natural Options Before Even Considering Painkillers for Chronic Pain

Once you've addressed the basics above, try these safe pain-relief techniques to help eliminate your pain without the need for prescription drugs:

• Emotional Freedom Technique (EFT): Few people want to be told that their pain is psychological or emotional in origin, but there's quite a bit of evidence that backs this up. Underlying emotional issues and unresolved trauma can have a massive influence on your health, particularly as it relates to physical pain. According to Dr. John Sarno, a psychiatrist who uses mind-body techniques to treat patients with severe low back pain, EFT has a greater than 80 percent success rate.
• Chiropractic adjustments: According to a study published in the Annals of Internal Medicine⁶ and funded by the National Institutes of Health, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain free in 12 weeks compared to those who took medication.
• Massage: Massage releases endorphins, which help induce relaxation, relieve pain, and reduce levels of stress chemicals such as cortisol and noradrenaline – reversing the damaging effects of stress by slowing heart rate, respiration and metabolism and lowering raised blood pressure. It is a particularly effective therapy for stress-related tension, which experts believe accounts for as much as 80 to 90 percent of disease.
• Acupuncture: Researchers concluded that acupuncture has a definite effect in reducing chronic pain, such as back pain and headaches – more so than standard pain treatment.⁷
• Relearn proper posture: The Gokhale Method addresses the root cause of physical pain, which is typically caused by improper posture. The method teaches you to reclaim your primal posture, which is the way your body was designed to stand, sit and move. You can also try Foundation Training—an innovative method developed by Dr. Eric Goodman to treat his own chronic low back pain. The exercises are designed to help you strengthen your entire core and move the way nature intended.
• Infrared Lasers therapy like K Laser can be profoundly effective and should be considered as an alternative before any surgical procedure for pain relief.

There Are Alternatives to Prescription Painkillers

If you have chronic pain of any kind, you don't have to make the hard choice to either suffer from your pain or suffer from the side effects of prescription painkilling drugs. Please understand that there are many safe and effective alternatives that provide excellent pain relief without increasing your risk of depression or any of the other health hazards that pain medications often cause.

• Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than prescription drugs like NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
• Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
• Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.
• Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
• Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.
• Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.
• Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
• Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.