Depression Linked to Prescription Drug Misuse in US Youths

Key Takeaways

• Among adolescents and young adults in a nationally representative US survey who reported a past-year MDE, 6.6% reported prescription psychotherapeutic drug misuse and 6% reported use disorder.
• The depression-associated difference in odds was larger for prescription psychotherapeutic drug use disorder than for misuse.
• Among youths who misused each drug class, those with MDE more often named helping with feelings and emotions as the main reason for misusing opioid analgesics (10.2% vs 3.7%) and tranquilizers (29.8% vs 13.2%).

In adolescence and young adulthood, does the frequency of prescription psychotherapeutic medication misuse—and the reasons youths give for it—differ by recent depression status? Youths with and without a past-year depressive episode provide the comparison for both reported misuse and its motivations.

Investigators in the JAMA Network Open study of depression and prescription psychotherapeutic drug misuse analyzed responses to the 2023 and 2024 National Survey on Drug Use and Health (NSDUH), a nationally representative, cross-sectional survey of noninstitutionalized people. The analysis included 22,906 adolescents aged 12–17 years and 27,723 young adults aged 18–25 years. Investigators compared respondents with versus without a past-year major depressive episode (MDE) on two primary past-year outcomes: prescription psychotherapeutic drug misuse and use disorder. Reported reasons for misuse were a secondary outcome. Survey-weighted prevalence estimates and logistic regression informed the comparisons.

Survey weighting yielded an estimate of approximately 9.8 million US youths with a past-year MDE nationally; that population estimate is distinct from the survey participant counts. Compared with youths without MDE, those with MDE had higher odds of reporting past-year prescription psychotherapeutic drug misuse: the reported odds ratio (OR) was 2.09, with a 95% confidence interval (CI) of 1.75–2.50. Both depression status and misuse concerned the past year, rather than a prospectively observed sequence.

The corresponding reported OR for prescription psychotherapeutic drug use disorder was 4.02 (95% CI, 3.37–4.80) for youths with versus without a past-year MDE. Among youths who misused opioid analgesics, 10.2% of those with MDE (95% CI, 6.4%–15.9%) named helping with feelings and emotions as the main reason, compared with 3.7% (95% CI, 2.2%–6.3%) of those without MDE (P = .01). Among tranquilizer misusers, the figures were 29.8% (95% CI, 21.1%–40.3%) vs 13.2% (95% CI, 5.8%–19.9%) (P = .003). These percentages are among youths who misused that drug class, based on the main reason given for the most recent misuse. 

Because depression status and drug-related outcomes were assessed in a cross-sectional, self-reported survey, the associations cannot establish whether depression preceded or caused misuse. The findings concern the noninstitutionalized population surveyed, and investigators did not test a treatment or screening intervention. The authors highlighted barriers to integrated mental health and substance use treatment for at-risk youths as a concern, without evaluating whether integrated care changes these outcomes.

Past-year depression coincided with greater reported prescription psychotherapeutic drug misuse and use disorder, alongside class-specific differences in reported emotional-coping motives; these remain observed associations, not a demonstrated causal pathway.

Clinician Questions

Do depression and prescription drug misuse findings in US youths apply to adolescents in institutional settings?

The nationally representative survey covered noninstitutionalized US adolescents and young adults, so its comparisons do not directly estimate patterns among youths in institutional settings.

Can the depression-associated odds ratios for prescription drug misuse in US youths show the absolute difference between groups?

Partly. The study reports prevalence in both groups: misuse was 6.6% with MDE vs 3.2% without, and use disorder was 6.0% vs 1.5% (both P < .001). That is a difference of about 3.4 and 4.5 percentage points. The authors did not report these differences themselves; they follow from subtracting the weighted percentages. The odds ratios (2.09 and 4.02) were adjusted for sex, race and ethnicity, and insurance status, so they are not interchangeable with the unadjusted percentages.