Off Label Use of Suboxone for Treatment Resistant Depression

Kamajian, George; Cable, Robert; Greco, Jonathan; Laughlin, Brady; deGroot, Tanya

doi:10.17756/jrdsas.2016-021

Cited by 4 publications

(6 citation statements)

References 7 publications

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“…In addition, the κ‐opioid receptor system may be partially responsible for the antidepressant effects seen with ketamine administration, 11 thus further implicating this pathwayʼs acute antisuicidal properties. BPNʼs rapid antidepressant effects have been replicated in other studies, including a 2016 report, which found that BPN‐NAL reduced Hamilton Rating Scale for Depression (HAM‐D) scores in patients with TRD, within 48 hours of the first BPN‐NAL dose, and were sustained throughout the course of treatment 12 …”

Section: Discussionmentioning

confidence: 81%

“…BPNʼs rapid antidepressant effects have been replicated in other studies, including a 2016 report, which found that BPN-NAL reduced Hamilton Rating Scale for Depression (HAM-D) scores in patients with TRD, within 48 hours of the first BPN-NAL dose, and were sustained throughout the course of treatment. 12 Evidence for BPNʼs direct antisuicidal and mood-stabilizing effects are just beginning to emerge; this has been shown in the reduction of suicidal ideation in both time-limited ultra-low doses of 0.1 to 0.5 mg BPN 13 as well as in single administration of high doses of 32 to 96 mg BPN. 14 Further investigation over this large range of doses and the relative µ-opioid and κ-opioid receptor occupancy levels may inform mechanistic hypotheses distinguishing the antisuicidal properties of the compound.…”

Section: Discussionmentioning

confidence: 99%

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

2020

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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.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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

2020

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“…Studies have shown that patients treated with buprenorphine exhibit significant improvement in depressive symptoms, as measured with the Hamilton Rating Scale for Depression (HAM-D), specifically with reduction in depressed mood, fatigue, and hopelessness (1). These improvements in depressive symptoms have been reported to occur within 48 hours of the first buprenorphine-naloxone dose and maintained throughout the course of treatment (1). Research also shows that while buprenorphine-naloxone causes a significant decline in depression severity during treatment, if discontinued suddenly, there is a significant increase in depressive levels (8).…”

Section: Discussionmentioning

confidence: 87%

“…Buprenorphine is an opioid medication typically prescribed for treating opioid use disorder. However, literature supports its utility for treatment-resistant depression (1). Buprenorphine has a unique method of action: it is a partial agonist of mu opioid receptors and an antagonist of kappa and delta opioid receptors (2).…”

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confidence: 99%

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

Lynch

Benhamou

2019

AJP Residents' Journal

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“…10,17 A recent open-label clinical trial evaluating BUP/NX for treatment-resistant depression in people with opioid use disorder (OUD) reported a significant reduction in depressive mood 48 h after BUP/NX initiation. 18 Karp and colleagues also found a significant decline in depression severity during BUP/NX treatment and a sudden increase when treatment was discontinued. 1 Methadone may also improve depressive symptoms, although studies are relatively limited.…”

Section: Introductionmentioning

confidence: 95%

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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Off Label Use of Suboxone for Treatment Resistant Depression

Cited by 4 publications

References 7 publications

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

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

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

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

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