We find Dr Daniell's hypothesis about OPIAD and depression provocative. Whether the degree of androgen deficiency induced by opioid use is sufficient to cause clinical depression and, if so, in what proportion of patients are questions warranting further investigation. We are not familiar with published data showing that depression in opioid-treated patients is more refractory to antidepressant therapy, though Dr Daniell's experience could be corroborated in future trials. One would need to carefully control for other confounders, separate from opioid use, which might complicate depression response in patients with chronic pain. We would be cautious about advocating testosterone treatment for depression in patients receiving opioids until further trials with OPIAD have been conducted.
Bair MJ, Robinson RL, Katon W, Kroenke K. Discussing the Depression-Pain Dyad With Patients—Reply. Arch Intern Med. 2004;164(7):804-805. doi:10.1001/archinte.164.7.805-a