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Since depression is a common symptom of sex-hormone deficiency and hypogonadism is quickly induced by opioid medications, the review of the relationships between pain and depression by Bair et al¹ might logically have included a discussion of opioid-induced androgen deficiency (OPIAD). Opioids inhibit gonadotropin production in most men soon after beginning therapy with sustained-action oral,² transdermal,³ or intrathecal⁴ opioids. A similar illness is present but less well documented in opioid-treated women.^3-4

Depression in patients with OPIAD seems likely to reflect, at least in part, the influence of exogenous opioids on the endorphin-dependent depression-related pathways discussed by Bair et al.¹

In my experience, depression in men with OPIAD often responds poorly to selective serotonin reuptake inhibitors or to other antidepressant medications until testosterone deficiency is treated with appropriate hormone therapy or until opioid use has been decreased to a level that allows resolution of androgen deficiency.

Harry W. Daniell, MD
Reading, Calif

1. Bair M, Robinson R, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163:2433-2445. FREE FULL TEXT 2. Daniell H. Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002;3:377-384. FULL TEXT | ISI | PUBMED 3. Daniell H. The association of endogenous hormone levels and exogenously administered opiates in males. Am J Pain Manage. 2001;11:8-10. 4. Abs R, Verhelst J, Maeyaert J, et al. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab. 2000;85:2215-2222. FREE FULL TEXT

Arch Intern Med. 2004;164:804.

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Depression and Pain Comorbidity: A Literature Review
Matthew J. Bair, Rebecca L. Robinson, Wayne Katon, and Kurt Kroenke
Arch Intern Med. 2003;163(20):2433-2445.
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