Depression: What’s Buprenorphine Got to Do With It?

Lynch, Sean; Benhamou, Ori-Michael J.

doi:10.1176/appi.ajp-rj.2019.140202

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…22 BUP/NX is thought to have a superior antidepressant profile than methadone due to its antagonist action on kappa opioid receptors. 10,15,18,23 BUP/NX also interacts with serotoninergic and hypothalamic-pituitary-adrenal systems, 10,19 two systems involved in the pathogenesis and maintenance of depression. To our knowledge, the only study that compared the effectiveness of methadone and buprenorphine (without naloxone) in decreasing depressive symptoms found that both treatments improved depression in heroin-dependent subjects.…”

Section: Introductionmentioning

confidence: 99%

Effects of Buprenorphine/Naloxone and Methadone on Depressive Symptoms in People with Prescription Opioid Use Disorder: A Pragmatic Randomised Controlled Trial

et al. 2022

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Objective This study aimed to evaluate the effectiveness of flexible take-home dosing of buprenorphine/naloxone (BUP/NX) and methadone standard model of care in reducing depressive symptoms in people with prescription-type opioid use disorder (POUD). This trial also evaluated whether improvements in depressive symptoms were mediated by opioid use. Methods Analyzed data came from the OPTIMA study (clinicaltrials.gov identifier: NCT03033732), a pragmatic randomised controlled trial comparing flexible take-home dosing of BUP/NX and methadone standard model of care for reducing opioid use in people with POUD. A total of 272 participants were recruited in four Canadian provinces. Participants were randomised 1:1 to BUP/NX or methadone. After treatment induction, past two-week opioid use was measured using the Timeline Followback every two weeks for a total of 24 weeks. Depressive symptoms were measured with the Beck Depression Inventory at baseline, weeks 12 and 24. Results Both BUP/NX and methadone significantly reduced depressive symptoms at week 12 (aβ ± SE = −3.167 ± 1.233; P < 0.001) and week 24 (aβ ± SE = −7.280 ± 1.285; P < 0.001), with no interaction between type of treatment and time ( P = 0.284). Improvements in depressive symptoms were only partially mediated by a reduction in opioid use (proportion mediated = 36.8%; 95% confidence interval = −1.158 to −0.070; P = 0.015). Conclusions BUP/NX and methadone showed similar effectiveness in decreasing comorbid depressive symptoms in people with POUD. This effect was partially explained by a reduction in opioid use. As both treatments seem equally effective, clinicians are encouraged to tailor the selection of OAT to patients’ needs and characteristics.

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