Author(s): Norman Stanley Miller and Thersilla Oberbarnscheidt*
The treatment of pain with opioid medications is a nowadays frequently discussed and concerning topic. Opioid medications have been prescribed since ancient years even though they are known to cause severe adverse reactions and co-morbid reactions. Depression and anxiety are the most common co-morbid psychiatric conditions observed in patients receiving opioid treatment. In the majority of cases, the provider for the pain medicine and the provider for the mood disturbance are not the same, which complicates diagnosis and treatment. The presenting symptoms of depression and anxiety are frequently not contributed to the opioid medication. Opioids cause anxiety through development of dependence and withdrawal as evidenced by the need to dose opioids frequently throughout a 24 h period. To treat opioid induced anxiety and depression associated with chronic use of opioid medications, physicians frequently concomitantly prescribe anxiolytics like benzodiazepines. Benzodiazepines significantly exacerbate both substance induced depression and anxiety. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) clearly requires the exclusion of the influence of a substance in order to diagnose major depressive disorder or generalized anxiety disorder but those are frequently given even though the patient is receiving treatment with opioid medications. Ultimately the correct diagnosis is crucial for the right treatment. This article is a review of literature discussing the correlation of opioid treatment and co-morbid psychiatric diagnoses including the differentiation as well as diagnostic criteria.
