June 28, 2017

Opioid Abuse Linked to Mood and Anxiety Disorders

New study provides support for a bi-directional pathway between non-medical prescription opioid use and opioid-use disorder due to non-medical use and several mood anxiety disorders

Individuals  suffering from mood and anxiety disorders such as bipolar, panic disorder and major depressive disorder may be more likely to abuse opioids,  according to a new study led by researchers from the Johns Hopkins Bloomberg School of Public Health. They found that mood and anxiety disorders are highly associated with non-medical prescription opioid use. The results are featured in a recent issue of the Journal of Psychological Medicine.

Prescription opioids such as oxycontin are a common and effective treatment for chronic and acute pain. Non-medical use of prescription opioids has increased dramatically and, according to the Substance Abuse and Mental Health Services Administration, prescription opioids are the second most frequently used illegal drug  in the U.S. after marijuana. Prescription opioids are highly addictive and prolonged use can produce neurological changes and physiological dependence. For the study, researchers examined the association between individuals with mood and anxiety disorders with non-medical prescription opioid use and opioid disorder.

“Lifetime non-medical prescription opioid use was associated with the incidence of any mood disorder, major depressive disorder, bipolar disorder and all anxiety disorders. Non-medical opioid-use disorder due to non-medical prescription opioid use was associated with any mood disorder, any anxiety disorder, as well as with several incident mood disorders and anxiety disorders,” said Silvia Martins, MD, PhD, lead author of the study and an associate scientist with the Bloomberg School’s Department of Mental Health. “However, there is also evidence that the association works the other way too. Increased risk of incident opioid disorder due to non-medical use occurred among study participants with baseline mood disorders, major depressive disorder, dysthymia and panic disorder, reinforcing our finding that participants with mood disorders might use opioids non-medically to alleviate their mood symptoms.  Early identification and treatment of mood and anxiety disorders might reduce the risk for self-medication with prescription opioids and the risk of future development of an opioid-use disorder.”

Using data from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC), a longitudinal face-to-face survey  of individuals aged 18 years and older between 2001 to 2002 and 2004 to 2005, researchers assessed participants for a history of psychiatric disorders. Non-medical use of prescription opioids was defined to participants as using a prescription opioid without a prescription or in greater amounts more often or longer than prescribed or for a reason other than a doctor’s instruction to use them. Logistic regression was used to determine whether lifetime non-medical prescription opioid use and opioid disorders due to this use predicted incident mood and anxiety disorders and the reverse. Researchers believe these findings provide support for a bi-directional pathway between non-medical prescription opioid use and opioid-use disorder due to non-medical use and several mood and anxiety disorders.

“With the current increased use of non-medical prescription drugs, especially among adolescents, the association with future psychopathology is of great concern. Using opioids, or even withdrawal from opioids, might precipitate anxiety disorders, suggesting that there is a subgroup of people who are vulnerable to future development of anxiety disorders,” said Carla Storr, ScD, author of the study and an adjunct professor with the Bloomberg School’s Department of Mental Health. Individuals using prescription opioids need to be closely monitored not only for the possibility  of engaging in non-medical use, but also for the development of co-morbid psychiatric disorders.

“Additional studies are needed to examine the relationship between non-medical prescription opioid use and prescription opioid-use disorder with mood and anxiety disorders since they could co-occur due to shared genetic or environmental risk factors,” Martins adds.

 

Story Source:

The above story is reprinted from materials provided by Johns Hopkins University Bloomberg School of Public Health.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

S. S. Martins, M. C. Fenton, K. M. Keyes, C. Blanco, H. Zhu and C. L. Storr Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychological Medicine, Available on CJO 2011 doi:10.1017/S0033291711002145

Disclaimer: Views expressed in this article do not necessarily reflect those of AnxietyAndPanicAttacksSite or its staff.

National Survey Dispels Notion that Social Phobia is the Same as Shyness

Normal human shyness is not being confused with the psychiatric anxiety disorder known as social phobia, according to an NIMH survey comparing the prevalence rates of the two among U.S. youth. The study was published online ahead of print October 17, 2011, in the journal Pediatrics.

Background

Social phobia is a disabling anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social or performance situations. Critics of the diagnosis have suggested that psychiatrists and pharmaceutical companies publicize social phobia, also known as social anxiety disorder, in order to increase sales of psychotropic medications, especially among youth. In addition, some have debated whether social phobia is just a “medicalization” of a normal variation in human temperament.

In response, Marcy Burstein, Ph.D., and colleagues at NIMH examined the rate of normal shyness among youth and its overlap with social phobia using data from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative, face-to-face survey of more than 10,000 teens aged 13-18 sponsored by NIMH. Social phobia was assessed using standard diagnostic criteria set by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV). To assess shyness, teens were asked to rate how shy they felt around peers that they did not know well.

Results of the Study

The authors found that while about half of youth identified themselves as shy, only 12 percent of shy youth also met criteria for social phobia in their lifetime. Moreover, among youth who did not identify themselves as shy, about 5 percent met criteria for social phobia, suggesting that social phobia and shyness are not necessarily directly related. Rather, the presence of social phobia may be independent of shyness in some instances.

In addition, those with social phobia were consistently more likely to also have another psychiatric disorder in their lifetime, like depression or a behavior or drug use disorder, compared to those who identified themselves as shy. Those with social phobia also showed higher levels of impairment in work or school, or among family or peers, though they were no more likely to be receiving professional treatment than those who were shy.

Finally, rates of prescribed medication use were low for all groups. Only about 2.3 percent of those with social phobia were taking the antidepressant paroxetine (commonly used to treat anxiety disorders), while 0.9 percent who described themselves as shy were taking it. In addition, those with social phobia were no more likely to be taking any prescribed psychiatric medication compared to the other groups.

Significance

The results suggest that social phobia is not simply shyness that has been inappropriately medicalized. Rather, social phobia affects a minority of youth and only a fraction of those who consider themselves to be shy. In addition, despite the greater disability that youth with social phobia experience and the greater likelihood that they will have another disorder, they are not more likely to be getting treatment compared to their peers, questioning the notion that these youth are being unnecessarily medicated.

Story Source:

The above story is reprinted from materials provided by National Institute of Mental Health.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

Burstein M, Ameli-Grillon L, Merikangas KR. Pediatrics. 2011 Nov;128(5):917-25.

Disclaimer: Views expressed in this article do not necessarily reflect those of AnxietyAndPanicAttacksSite or its staff.