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A descriptive study of antidepressant use in people prescribed opioids for non-cancer pain

Why the research is needed

Opioids are strong medicines that are prescribed to relieve pain, and antidepressants are medicines that are prescribed for several reasons, including depression, anxiety, other mental health conditions and pain relief. Taking antidepressants and opioids at the same time (co-prescribing) may have some negative outcomes, for example the treatments may not work as well. There is a complex relationship between pain and depression, and there are known interactions between opioids and antidepressants. Co-prescribing may become even more common as the National Institute for Health and Care Excellence (NICE) has recently recommended prescribing some antidepressants as a first drug treatment for pain.

What we will do

This study will describe co-prescribing of opioids and antidepressants between 2010 and 2019 in England using anonymised primary care data from the Clinical Practice Research Datalink (CPRD). People with a record of cancer, terminal illness, or opioid use disorder will be excluded. This project has two aims:

  • Aim 1 - To determine the extent of co-prescribing of opioids for non-cancer pain and antidepressants. We will calculate the rate of co-prescribing of opioids and antidepressants for all adults in CPRD, describing the trends and variation overall and in each calendar year. We will also look at results separately by sex, age group, practice region, deprivation, and ethnic group.
  • Aim 2 - To describe the population of people co-prescribed opioids for non-cancer pain and antidepressants. We will then focus on the group of people who had an opioid prescription between 01 January 2010 and 31 December 2019. For this group we will describe and compare the characteristics of those who were and were not co-prescribed antidepressants. 

How patients and the public are involved

Three public contributors are part of our project team. They helped come up with the research questions and design the study taking insight from their lived experience. They will help interpret the findings of our study, discuss the implications and advise on dissemination.

What the benefits will be

This information will be useful to help GPs, policymakers and other researchers understand how many people may be at risk of harm from using both types of medicines at the same time. It will also help researchers design future studies about the safety of using these two medicines at the same time. 

When the findings will be available

The findings will be available at the end of 2023.


Dr Ruth Jack,

Mr Jake Butler,