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Response to Ruan et al. Letter to the Editor: Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients

      We appreciate the thoughtful comments of Ruan et al,
      • Ruan X.
      • Chiravuri S.
      • Kaye A.D.
      Increased risk of depression recurrence after initiation of prescription opioid in noncancer pain patients.
      regarding the definition of depression used in our recent study on the association between opioid use and depression recurrence.
      • Scherrer J.F.
      • Salas J.
      • Copeland L.A.
      • Stock E.M.
      • Schneider F.D.
      • Sullivan M.
      • Bucholz K.K.
      • Burroughs T.
      • Lustman P.J.
      Increased risk of depression recurrence after initiation of prescription opioids in noncancer pain patients.
      The authors argue that using International Classification of Diseases, Ninth Revision (ICD-9) code 311 is not an appropriate measure for major depression. Selecting an ICD-9 code for depression is multifactorial and partly influenced by whether patients were treated in specialty mental health care or primary care. We do not have enough information to distinguish between major depressive episode and the less specific clinical features of sadness and depressed mood related to ICD-9 code 311. Therefore, we refer to our outcome as depression, not major depression or by any other qualifier. Had we excluded 311 from our depression diagnosis, the results would have been seriously biased because many of these patients would be misclassified as nondepressed.
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      References

        • Ruan X.
        • Chiravuri S.
        • Kaye A.D.
        Increased risk of depression recurrence after initiation of prescription opioid in noncancer pain patients.
        J Pain. 2016; 17: 944-945
        • Scherrer J.F.
        • Salas J.
        • Copeland L.A.
        • Stock E.M.
        • Schneider F.D.
        • Sullivan M.
        • Bucholz K.K.
        • Burroughs T.
        • Lustman P.J.
        Increased risk of depression recurrence after initiation of prescription opioids in noncancer pain patients.
        J Pain. 2016; 17: 473-482

      Linked Article

      • Increased Risk of Depression Recurrence After Initiation of Prescription Opioids in Noncancer Pain Patients
        The Journal of PainVol. 17Issue 8
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          We read with interest the article by Scherrer and colleagues3 published in The Journal of Pain. The authors conducted a retrospective study using data from Veterans Health Administration (VA; n = 5,400), and Baylor Scott & White Health (n = 842). They reported that patients exposed to an opioid compared with those unexposed had a significantly greater risk of depression recurrence in both patient populations. They conclude that their results suggest opioid use doubles the risk of depression recurrence even after controlling for pain, psychiatric disorders, and opioid misuse.
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