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Certain Opioids Less Effective With SSRI Antidepressants

Surgical patients on SSRIs + prodrug opioids had higher postsurgical pain 8 weeks postdischarge

FRIDAY, Feb. 8, 2019 (Pharmacist's Briefing) -- Certain opioids are less effective for postoperative pain in patients taking selective serotonin reuptake inhibitor (SSRI) antidepressants, according to a study published online Feb. 6 in PLOS ONE.

Arjun Parthipan, from Stanford University in California, and colleagues used a machine learning approach to identify patients prescribed a combination of SSRIs and prodrug opioids postoperatively to examine the effect of this combination on postoperative pain control. The authors developed algorithms to extract depression-related information (diagnosis, SSRI use, symptoms) and used electronic health records to capture information about medications, vitals, and demographics.

The researchers identified 4,306 surgical patients with symptoms of depression. Of these, 14.1 percent were prescribed both an SSRI and a prodrug opioid, 29.4 percent were prescribed an SSRI and a nonprodrug opioid, 18.6 percent were prescribed a prodrug opioid but were not on SSRIs, and 37.5 percent were prescribed a nonprodrug opioid and were not on SSRIs. Patients taking an SSRI and a prodrug opioid had significantly worse pain control at discharge and three- and eight-week follow-up versus patients taking an SSRI and a nonprodrug opioid. There was no difference in pain control by prodrug opioid among the patients not taking SSRIs. An increase or decrease in pain scores at discharge, three-week follow-up, and eight-week follow-up was accurately predicted by the machine learning algorithm (mean area under the receiver operating characteristic curve, 0.87, 0.81, and 0.69, respectively). The strongest predictors of postoperative pain control were preoperative pain, surgery type, and opioid tolerance.

"Depressed patients are at greater risk for pain, and we're failing them because we're not educated enough about the drugs we're giving them," a coauthor said in a statement.

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