What is opioid-induced depression?

Discover the link between opioids and depression, and how to minimize risks. Explore the impact on mental health and treatment options.

Ophelia team
Opioid-induced depression
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Fact checked by
Ashley Mazei, NP

While the addictive properties of opioids are well known, the mental health repercussions are less frequently talked about. Unfortunately, opioid use disorder (OUD) may be linked to issues like depression and anxiety.

One study of some 100,000 patients prescribed opioids found that approximately 10% developed depression after using the medication for one month. Early research on the subject suggested that some 53% of OUD patients also have some sort of mental health issue. But can opioids cause depression?

Below, we explore the link between opioid use and mental health issues, particularly depression, and discuss some steps you can take to minimize the risk of mental health problems following opioid use.

How the nervous system impacts mental health

To understand the impact opioids can have on mental health, it helps to recognize why problems like anxiety and depression occur in the first place. A big part of mental health relates to the nervous system, which plays a role in many bodily functions, from digestion and heart rate to sweating, speaking, and even breathing.

More broadly, the nervous system helps us determine how to respond to perceived threats, activating the fight-flight-or-freeze instinct you may have heard of. If your brain perceives a threat, the nervous system will spur the release of adrenaline and cortisol—sometimes called "the stress hormone"—by the endocrine system. This can cause physical symptoms, like a racing heart and sweaty palms.

Research suggests that chronic activation of that fight-flight-or-freeze response can contribute to depression and anxiety, which may go hand in hand. It can also take a physical toll, increasing the risk of health problems like high blood pressure.

The link between opioids and depression

Research suggests that some one in four people with a diagnosed mental health issue also have substance use challenges. Relevant diagnoses include schizophrenia, bipolar disorder, and depression.

Opioids are linked to depression specifically in a couple of ways. In some cases, opioids may be used as a short-term solution for depressive symptoms, contributing to dependency issues and potential OUD.

This is because opioids trigger the release of neurotransmitters in the brain, including dopamine and serotonin. These "feel good" neurotransmitters can incite positive mental and physical feelings. Due to this uplifting effect, opioids may initially provide a temporary respite from depression symptoms, like feelings of sadness.

The problem is that this relief is only short-term. As time goes on, the individual will need a larger dose of opioids to achieve the same effect. If use persists, the opioids can lose their impact on depressive symptoms.

Alternatively, it's been shown that opioid use can contribute to depression, even in people who haven't experienced symptoms previously. This likely stems from the fact that opioids disrupt normal brain function, influencing the release of neurotransmitters, as described above.

Depression can have varied effects on both the brain and body. Although depression is usually framed as a mental health disorder, it impacts the body as a whole. Symptoms of the illness may include the following:

  • Feelings of sadness, grief, guilt, or hopelessness
  • Irritability or anger
  • Loss of interest in things that once brought pleasure
  • Headaches
  • Chronic body aches
  • Difficulties maintaining work or social obligations
  • Loss of interest in sex
  • Fluctuating weight
  • Difficulty with memory or decision-making 
  • Trouble sleeping

Depression is also associated with an increased risk of alcohol or substance misuse. In the long term, it can have additional physical effects, like a weakened immune system. There are also unique symptoms that can point to OUD occurring with depression, including extreme weight loss and nodding out.

Behavioral changes, like stealing money or valuables and lying about drug use, can also be red flags. In the worst-case scenarios, individuals may have suicidal thoughts or actions. In such instances, emergency care is essential.

Managing mental health during Suboxone® treatment

Suboxone may be prescribed as part of a medication for addiction treatment (MAT) regimen for individuals living with OUD (important safety information). It is considered the gold standard in OUD care, with support as a treatment option from the World Health Organization (WHO) and the US Department of Health and Human Services, among others. It has been approved by the US Food & Drug Administration (FDA) since 2002.

Individuals undergoing Suboxone treatment may also experience improved mental health. Research suggests that buprenorphine, one of the crucial components of Suboxone, may have antidepressant properties. This means that it may be able to address not only OUD but also an underlying mental health issue if one is present.

There is evidence that suggests that Suboxone can increase levels of serotonin in the brain, resulting in an improved mood. More generally, Suboxone can reduce withdrawal symptoms for people battling OUD—like nausea, cramps, and agitation—leading to a better quality of life overall.

Case studies of patients prescribed buprenorphine-naloxone have shown an improvement in depressive symptoms with treatment. In fact, buprenorphine-naloxone has been prescribed "off label" (meaning it's not technically FDA-approved for this particular use) for patients with depression if they do not respond to treatment with other antidepressants.

Both OUD and the OUD treatment can bring ups and downs. This is why communication is so critical. Individuals seeking care for OUD should communicate changes in mood, good or bad, to their healthcare providers. Taking steps like keeping a journal to monitor both physical and mental changes can be beneficial as well.

Monitoring is especially critical for individuals who are also taking medication for anxiety or depression. This is because Suboxone can interact with certain medications, with potentially dangerous effects. Individuals taking tricyclic antidepressants, SSRIs, SNRIs, or benzodiazepines should be especially cautious and always seek professional medical advice.

Comprehensive OUD support with Ophelia

Ophelia helps people with OUD access MAT online. Our care team ensures eligible patients can pick up a Suboxone prescription at a local pharmacy and have access to personalized care on your schedule, including mental health support online. This comprehensive approach addresses the medical aspects of OUD as well as the psychological and social ones, so every patient gets the support they need to thrive.


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