A systematic review and meta-analyses of longitudinal studies on mood and anxiety symptoms following prescription opioid use.

To review evidence from longitudinal studies on the association between prescription opioid use and common mood and anxiety symptoms. We conducted a systematic review and meta-analysis according to PRISMA guidelines. We searched PubMed, Embase and PsycINFO for search terms related to opioids AND (depression OR bipolar OR anxiety OR post-traumatic stress disorder [PTSD]). Findings were summarised narratively, and random-effects meta-analyses were used to pool effect sizes. We identified 10,290 records and found 10 papers that met our inclusion criteria. Incidence studies showed that people who used prescription opioids had an elevated risk of any mood (adjusted effect size [aES]=1.80 [1.40-2.30]), and anxiety outcomes (aES=1.40 [1.20-1.80]), compared to those who did not. Associations with depression were small and not significant after adjusting for potential confounders (aES=1.18 [0.98-1.41]). However, some studies reported an increased risk of depressive symptoms after increased (aES=1.58 [1.30-1.93]) or prolonged opioid use (aES=1.49 [1.19-1.86]). Mental health should be taken into account when prescribing opioids because some patients may be vulnerable to adverse mental health outcomes.