Case Report: Buprenorphine—A Treatment for Psychological Pain and Suicidal Ideation?

Abstract

Background and Objectives: Buprenorphine is commonly used to manage opioid use disorder; however, the literature describes its potential role in treating treatment-resistant depression. Methods: We present a patient with bipolar disorder and opioid use disorder, who presented status post-suicide attempt. Results: After initiating buprenorphine-naloxone, the patient reported rapid improvement in depressive symptoms, pain, and suicidal ideation. Discussion and Conclusions: This case demonstrates buprenorphineʼs antisuicidal and mood-stabilizing capabilities, potentially via antagonizing κ-opioid receptors as well as reinstating the balance between reward and antireward circuitry. Scientific Significance: This case highlights buprenorphinenaloxone as a treatment for both treatment-resistant depression and opioid use disorder, as well as buprenorphineʼs rapid antidepressant, analgesic, and antisuicidal effects.

Depression and Suicidal Ideation among Patients Receiving Opioid Maintenance Treatments Considering Cognitive Flexibility

“…The present study showed that the rate of suicidal ideation was lower among patients treated with buprenorphine maintenance compared to other drugs. This difference was even statistically significant between the opium tincture and the buprenorphine groups of treatment, which is consistent with the findings of previous research demonstrating buprenorphine’s anti-suicidal and mood-stabilizing capabilities ( 1 , 45 - 48 ). This finding highlights buprenorphine as a treatment for depression, as well as its anti-suicidal effects.…”

Mechanisms Underlying the Anti-Suicidal Treatment Potential of Buprenorphine

“…In another case report, a patient with cannabis-induced psychotic disorder and opioid depressive disorder with severe suicidal thoughts was treated successfully with a single high dose (96 mg) of buprenorphine [ 160 ]. Another case report showed that buprenorphine/naloxone (8 mg/2 mg) was effective in reducing pain and suicidal ideation in a 39-year-old male with a history of bipolar disorder, multiple suicide attempts, and polysubstance abuse [ 161 ]. Chart reviews of suicidal adult depressed patients with comorbid chronic pain and opioid use disorder who received off-label buprenorphine also found some support for the anti-suicidal properties of buprenorphine [ 162 ].…”