Depression and pain often go hand in hand. It’s not uncommon that many people who see specialists to treat their chronic pain also have a history of depression. At the same time, their pain tends to resist treatment, so they often end up taking opioids, such as codeine or hydrocodone (Vicodin and others, including generics), which are strong painkillers and should be a last resort. The trouble is that clinical trials to test opioid drugs have typically excluded people with depression because they’re vulnerable to becoming addicted. So it’s unknown how well opioids even work, if at all, or if they are safe for people with depression to take. It’s also not known whether opioids are effective or safe for long-term use in general, because most studies have lasted for only a few weeks or months.

The researchers said another concern is that opioids may mask depression symptoms and distract people from getting treatment, such as psychotherapy and antidepressant medicines, that could help alleviate their depression.

In our Best Buy Drug report on opioids, for people with chronic pain, we recommend trying less risky pain relievers such as acetaminophen (Tylenol or generics), ibuprofen (Advil or generics), or naproxen (Aleve or generics) before opting for an opioid. And for more information about depression and drug treatments, see our Best Buy Drug report on antidepressants.

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs

For more on understanding and treating depression, see the risk factors and our comparison of 18 drug and non-drug treatments (subscribers only), including counseling, St. John's wort, and SSRIs.