Depression Doubles Prescription Drug Misuse Risk in Youth

Youths experiencing a major depressive episode face more than double the odds of misusing prescription psychotherapeutic drugs and four times the odds of having a prescription drug use disorder compared to peers without depression, according to a study published on October 16 in JAMA Network Open.

Depression Rates And Prescription Misuse

Led by Michael S. Toce, MD, MS, of Boston Children’s Hospital, researchers analyzed responses from the 2023 and 2024 National Survey on Drug Use and Health. The cross-sectional study included 50,629 participants, capturing a nationally representative sample of noninstitutionalized individuals in the United States.

Survey data showed that 16.3% of respondents reported a past-year major depressive episode, translating to an estimated 9.8 million individuals nationwide. Among youths with a past-year major depressive episode, 6.6% reported misusing prescription psychotherapeutic drugs, compared to 3.2% of those without. Furthermore, 6% of youths with a past-year major depressive episode had a use disorder, versus 1.5% of those without.

Motivations For Drug Misuse Among At-Risk Youths

When examining self-reported motivations, investigators found that youths with a past-year major depressive episode who misused opioid analgesics and tranquilizers were more likely to do so to “help with feelings and emotions” than those without. Specifically, 10.2% of participants with a past-year major depressive episode reported misusing opioid analgesics for this reason, compared to 3.7% of participants without. For tranquilizers, 29.8% of youths with a past-year major depressive episode reported this motivation, versus 13.2% of their peers without.

Adjusted statistical models accounted for sex, race and ethnicity, and insurance status. These adjustments confirmed that the elevated risk remained substantial, yielding an odds ratio of 2.09 for prescription drug misuse and an odds ratio of 4.02 for prescription drug use disorder among youths with a past-year major depressive episode.

Study Limitations And Clinical Implications

The study authors noted several important constraints in their published findings. Survey responses were subject to reporting bias. Because the research used a cross-sectional design, investigators could not establish causal inferences.

Additionally, the survey did not assess mental health conditions other than depression, and individuals experiencing homelessness were excluded from the sample. Researchers emphasized that drugs could not be directly compared owing to different motivations for misuse.

These findings suggest the need to identify barriers to integrated mental health and substance use treatment for at-risk youths before patterns of self-medication progress to substance use disorders.

Study authors