Comments on
Opioids for Depression?


addictionI recently received the following note from a reader:

I am aware of historical and recent studies where Subutex (a ‘partial agonist’ opioid called buprenorphine) was used very successfully in the treatment of depression.

25 thoughts on “Opioids for Depression?

  • September 21, 2011 at 1:01 pm

    That really is shocking that they are now starting to treat depression with opiods. When I was a psych resident, opiods were prescribed and abused all over the place. I can’t believe it’s come to this point where it’s being used to treat depression. It is so true that it can lead to suicide as well. Thank you for bringing this to our awareness.

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    • April 30, 2013 at 6:27 pm

      Not all Antidepressants are non addictive.
      Some, like Effexor, can cause extremely high blood pressure, and “eletric brain zaps” that can last for monthis after tapering off. Lexapro can do this also.
      Therefore, subutex is no more harmful, maybe even less so, than any of the common market antidepressant meds when tapering off.
      But this question of “tapering off” is a moot point. Most depressants are on meds for life.
      Therefore, subutex evaluation should be based on effects of use, not stopping. Lets be real for once!
      I’d rather be on Subutex than prozac! The part of my brain that doesn’t produce natural mood elevators are the endorphin, not serotonum uptake.
      We become so concerned about “addiction” that we harm people who may need something like subutex to feel alive! In the old days, elavil was administered, a horrible drug which effected the brain’s memory. One could not remember which day, nor place they were!
      I could go on. But the time has come in our society to be open minded about depression treatment and not archaic, these attitudes will only hurt the patient. Comments please? Remember, anyone who needs to take an antidepressant is dependant, whether it be Abilify or Subutex. Let’s stop the discrimination of the “opioid” connotations and be truly progressive in new approaches otherwise there will be a rise in mental illness in this country that is larger than the one we have. God bless the USA!

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    • April 30, 2013 at 6:32 pm

      Why would anyone be skeptical about Subutex used for depression? This is outrageous. Some of the modern ANti d’s have such sever side effects but because they are supposedly non habit forming they are miracle drugs. False claims! The public must read through the tupe of thinking that will turn this country into a corall of lunatics! Concerned! Really, about the logic people use.

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    • April 30, 2013 at 8:23 pm

      I can’t see how something like subutex can cause suicidal thinking; moreover, the harmful thoughts are there long, lreong time before the drug was perscribed. Usually, it isn’t the drug that caues suicide, it is the event that leads up to the thoughts, certainly not the drug. The drug gives a feeling of well being, quite effective. If one commites suicide on a drug, they’ll blame the drug. Did anyone ever consider the problme was there long before the drug was administered; wE ARE ON THE WRONG TRACK!

      Reply
  • September 21, 2011 at 11:25 pm

    Back before SSRIs, depression was treated with MAOIs, opioids, or stimulants.

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  • September 22, 2011 at 11:53 am

    I thought this was a brilliant article raising many questions. I do many many patients who feel the the Subutex helps their mood. We have a tremendous heroin epidemic here in St. louis area causing many premature deaths (particularly with our teens) The problem and awareness has grown so badly that Schools are finally admitting that its a problem. Thank you for your insights!

    Reply
  • September 22, 2011 at 2:21 pm

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    Reply
  • September 24, 2011 at 1:18 am

    There are studies that show that opioid addicts have an endorphin deficiency and one of the symptoms of endorphin deficiency is severe depression. There seems to be a disagreement of whether this is caused by the use of opiates or if it’s something that preceded the addiction and maybe even caused it. If the latter is true it’s quite possible that there are a lot of people out there that are not addicts but suffer from an endorphin deficiency that causes depression. Many people believe this to be the case and believe that the only way to treat this kind of depression is to supply the brain with artificial endorphins in the form of opiates. A lot of methadone patients who have struggled with depression their whole lives attest to being free from depression and feeling completely normal since starting methadone treatment. I understand that anecdotal information is not evidence but I think it’s something that should be considered.

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    • September 24, 2011 at 6:40 pm

      I’m not certain about the strength of the studies, but I think it is clear that opioids impact mood, and science has steered clear from considering that connection as a source of new treatments– i.e. because of the fear of the dark side of opioids.

      Aside from your comments about methadone, I know many people on buprenorphine who say that they struggled with depressioni for years, but have been in remission from depression (and addiction) since startng buprenorphine. As I mentioned, I’m not at the point where I would use an opioid for a depressed person, UNLESS that person already had an opioid problem.

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      • April 30, 2013 at 8:32 pm

        iN RESPONSE TO THE DOCTOR, WHY WOUDN’T YOU CHOOSE SUBUTEX for DEPRESSION? If it works don’t fix it?

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      • March 9, 2015 at 6:44 pm

        I would like to know if you know of anyone around toledo ohio who would treat depression with subutex? I can say i have been on many antidepressants and lithium none of them worked for me.

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      • March 9, 2015 at 8:34 pm

        I will post your question, but understand that buprenorphine is not approved for treating mood disorders, including depression. That said, many medications are used ‘off label’ for a range of conditions.

        I myself would be reluctant to treat depression with buprenorphine, if the person didn’t also have opioid dependence. It is hard to start buprenorphine in someone not tolerant to opioids, as you have to taper up very slowly to avoid the risk of respiratory depression and other opioid effects. Also, one on buprenorphine, you would have to experience significant withdrawal (and the depression that is part of withdrawal) to discontinue the medication.

        Alkermes has an antidepressant medication in the pipeline that conists of buprenorphine plus an antagonist, to avoid opioid tolerance. We’ll see how it does during the clinical trials process….

        Reply
  • February 10, 2012 at 7:44 am

    Buprenorphine has been shown to be a life saver for those specific treatment resistant depressed patients via kappa antagonism (calms the overactive brain) and pharmaceutical companies are fully aware and within this decade they will produce specific kappa blockers which would work much better and wouldn’t have to rely on potential addiction of a mixed agonist/antagonist like buprenorphine. Kappa antagonists are great anxiolytics too.

    When a patient has tried everything including ECT and they all fail, buprenoprhine at a low dose outweighs suicide everytime in my professional option. We do the same for cancer patients but in this case it’s the patient’s quality of life and prevention of suicide that matters.

    WHO predicts suicide to become second only to heart disease by or before 2020. The neuropharmaceutical company Alkermes just completed phase I of ALKS 5461 (buprenorphine and mu antagonist) for MDD (also cocaine addiction) with such great success that they have accelerated the beginning of phase II.

    There was no such thing as treatment resistant depression when physicians used opioids (and sleep deprivation to calm the overactive brain) prior to the development of the first antidepressant in the mid 1950’s by accident, but yes there was addiction as they didn’t have buprenorphine then.

    I believe some individual inherently lack endorphins or have an overactive brain as shown by Emory University’s Helen Mayberg’s (M.D.) deep brain stimulation imaging studies where depressed patients only go into remission after brain overactivity is brought back to normal otherwise these patients stay in a TRD state.

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  • July 2, 2012 at 6:41 pm

    As someone with severe depression, and treatment resistant depression, I’ve already resigned myself to being on certain drugs until I die (of old age, I hope!). And if I am even an hour past when my Effexor needs to be taken, I have severe withdrawl and side effects. So to someone as desperate as me, how is what I do now any better than risking addiction? I know they say it is, but it doesn’t always feel that way.

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    • November 11, 2017 at 1:02 pm

      I totally understand & agree with you, Mariah. Even though we don’t know each other, I honestly wish you well. I’m thinking that at my age, 53, & having tried everything under the sun, I’m SOO disappointed in what’s available. Only today have I heard of different options which have never been made aware to me. I’m happy your Effexor works for you. I’, a firm believer in “Better living through chemistry.” I wish you continued luck & a BIG slice of happiness we all deserve !!! Peace, Henry

      Reply
  • February 3, 2013 at 1:43 pm

    I have suffered from depression all of my life. I had an injury and began to take opioid pain medication which instantly made me feel better in regards to my mental health. This was short lived however. I never could control my intake and the depression only became worse and worse as a result. When the medication stopped working for both my pain and depression my intake increased and I had a full on addiction. This went on for ten years. I became so depressed I attempted suicide on four different occasions, which I had not done before. I was hospitalized and began methadone which had a new set of problems. Later suboxone was tried.I have been off of suboxone for 5 weeks. This was equally difficult.I think that both are good medications but I didn’t want to be on them for life. I am struggling still. I don’t recommend taking suboxone for depression. I have not found it to be the magical treatment it was touted to be. It does make withdrawal easier but the withdrawal from suboxone is equally difficult and it did nothing for my depression. I have been told I am the first patient in 10 years of it being available to have discontinued the medication. Now I am where I was before, mildly blue. I manage without medication. Careful what you wish for. I have tried every anti depressant available and nothing made a difference really. I became increasingly down with each failure and the side effects were troubling. Opioids initially gave me the response I had been looking for but this was short lived and dependency took over.

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    • February 3, 2013 at 11:57 pm

      Thank you for sharing your story, and I hope you find a better life. The idea, though, that you are the first person to stop Suboxone has no merit; I have known over 200 people who stopped Suboxone from my own practice alone, since about 2006. The reason I’m not a fan of going off Suboxone has nothing to with the withdrawal— which is miserable, but clearly less difficult than the withdrawal from agonists— but rather because opioid dependence is a relapsing illness with a high fatality rate. One outcome study had fatality rates of 7% in one year after going off Suboxone. People with peptic ulcers generally stop their meds when the ulcer has healed, whether or not changes were made in diet and lifestyle; if 7% of the people who stopped taking Prilosec died within a year, guidelines would call for people to stay on the med indefinitely.

      Of course, someone taking Prilosec is considered ‘compliant’; someone on longterm Suboxone is considered ‘almost using’. Nope– no sigma there!

      Reply
    • April 30, 2013 at 8:37 pm

      Suboxone is not a good choice for depression as the naloxone gives one major headaches and discomfort. I’d try subutex for depression, definitely not suboxone.

      Reply
  • February 15, 2013 at 7:15 pm

    Hello, I have a Bipolar condition, which is much more in the category of BP 2 however, I have had two manic episodes, therefore i fit the criteria of Bipolar 1 Also, I have OCD and PTSD. I barely even have any hypo-manic symptoms and as i aged my disorder graduated into chronic Major depression with Leaden Paralyses. It an awful state and it is no wonder that people give up and take their lives. Then, by accident I tried a pain killer called dilontin and noticed an effect which was of a miracle to me and I was finally liberated from, the dreadful state that I had been in for so many years. I have closely monitored myself and given the utter stupidity of the medical community not prescribing me what I needed, I was forced into using heroin which, I have used for the last 3 years with no problems of addiction or bad side effects. With the Opiates, I have my life back and feel fantastic. I finally convinced one very skeptical Dr. that I was having great success on the Heroin however, I don’t like breaking the law or, supporting he drug economy, not to forget the financial cost. She prescribed what i suggested and the 8 mgs of Dilantin a day, however it wasn’t quite enough and i found 12 mgs “perfect” with the other prescribed medications, which were only working at about half speed. I coincidentally just got back from my now former Dr.for she was accusing me of being a drug addict and I repeatedly told her, if I were adrug addcit then, you must have an alternative, for treating refractory Depression and stated, lets start right now and I will stop taking the opiates immediately. As usual, she did not have an alternative and was adamant that i was suffering from addiction not refractory Depression. I have been on every antidepressant there is and they last for a while and then, back to the same old story. I have used Thyroid meds for an augmentation, which worked very well and i immediately stopped taking the opiates, which i will add, I had no withdrawal from. I was enjoying mylife without then opiates, over about a 14 month period then, my worst nightmare began again and I was sliding into full blown leaden Paralysis. So, i got back onto the opiates and my symptoms completely subsidized and i was feeling fantastic and all was well, that is, until dealing with the medical community again, which almost killed me.They keep saying this is an addiction problem and nothing to do with refractory depression well tell me that when I stop the opiates and my entire system shuts down and i can barely move or talk. I wish to God tht it was an addiction problem, however it can not be given that, I have quit on my own will when a suitable substitute has been introduced also, i have not had any problems, with using Hypodermics or increasing the opiates, that being using “Heroin” off and on now for 4 years. I keep asking if this is not the way to treat refractory Depression then certainly you have an alternative to augment my meds so I can have a life just like you and all the Dr.s always give me the blank stare, with no answer…So, there method is to let me slide into Leaden Paralysis and Major Depression, because opiates are addictive…However as i pointed out to all the Dr’s and also Psychiatrists that they do not have any problems of prescribing scores of benzodiazepine, which is far more addictive than, opiates and also much harder on ones liver and kidneys. Again, the medcial communites utter hypocritical methods are overlloked. I also notice how they do not take any notice or concerned with my tobacco addiction, and my respiratory disease, that is Asthma that i suffer from…I think it is common sense that the tobacco addiction is the one to be addressed, but their is almost a fanaticism with opiates being the black sheep of drugs.Well, this Dr. said i will give you some more Dilotins but then, i want you to see an addictions Dr to get on Methadone and as i was just informed from an expert on medications, that Methadone will not augment the other meds and is useless, in comparison to stronger opiates for treatment of refractory Depression so, i just fired her and gave back her prescription of Dilotin’s That isn’t the behaviour of an addict, she prescribed me about 60 4mgs of dilantin and out of principle, I tore the prescription up and wrote thanks on the back and gave it to her nurse…I was also “given” 90 Oxycontin’s and i did not Like them, for I was having side effects so,i gave them back, again, that is not conclusive behaviour of an addict also, i have intentionally stopped taking the opiate for a few days to see what would happen and there is absolutely no withdrawal, from the opiates however, from the benzodiazepine, that they have had me on for 25 years gives me withdrawl as does the Dexedrine as well…after a few days, i star to sit down and become almost Catatonic then, i introduce the opiate again and all symptoms, subside and i feel fantastic and can do all the things i love again and the medical community is doing their best to stop me from taking any opiates, with my cocktail of meds and as usual they do not have any alternatives, so in other words, they would prefer me to be in Major Depression coupled with Leaden Paralyses, and having vivid thoughts of suicide than me taking an opiate and enjoying my life. The biggest challenge with this disease, that thousands of us find is, the ignorance of the Medical community whom are bent on hurting us with their archaic and hypocritical methods, of treating Refractory Depression. i have now, given up on all Dr.s and i am so much better off and really enjoying my life with absolutely no side effects or signs of losing control to serious opiate addiction, which i have been using for the last 3 years, with complete success and i have had minimal symptoms and everyone whom is close to me, sees the incredible difference in me and constantly tell me how good i look and most importantly, how “happy” and pleasant i am…for the first time in 10 years i am considering working part time and seem to be getting stronger as time goes by…The Opiates work, what does not work, is the medical communities ignorance, which is more than likely the number one cause of suicide, due to their insane, full pun intended,and hypocritical methods, such as prescribing scores of Benzodiazepine and also, strong sleeping pills and Dexedrine…

    To all Medical professionals you are killing a lot of people with your ignorance and please see that refractory Major Depression,. coupled with Leaden paralysis is a death sentence in its self and i would prefer to physically die, than go back to that living hell… So, for some people opiates are our saviour and the Dr.s are the menace, which cause us so much grief, in our plight to obtain a simple pain killer that, not only gives us our lives back but also, saves our lives…please here are screams of injustice and please give the opiate a “chance” at least..

    Thank you for your time and any responses would be most appreciated.

    Reply
  • February 19, 2013 at 12:31 am

    It would be irresponsible of me to not mention that using opiates will not work for everyone,some people can not take them and it can be extremely dangerous. If you are not familiar with Heroin then do NOT use it on your own and you NEVER use a hypodermic needle with it, you snort that is using the nose very, very small amounts and again, you must be learned in this, I am from the tougher side of the tracks and have been round drugs all of my life and I have also, witnessed the utter destruction that they can cause. If you can avoid Heroin then avoid it!!!Try to obtain painkillers, that are classed under the opiates such as Hydromorphone. Start off with very very small doses and find what you need and if you start increasing the dose, once you have found what you “honestly” need, that will be your death sentence.If it feels as if it not working after a while then you MUST take a week off and get the tolerance down. you can use very small doses of Tylenol 1 or 3 to ease any withdrawal. Also, Dexedrine is an excellent medication for leaden paralyses and can also be successful in the augmentation process of antidepressants. Often a very strange cocktail of medications is required for people whom are of refractory with antidepressants. One very well known medications that helped me a lot was a thyroid medications called Cytomel…There are websites to check out as well one is called “Ignorance Kills” also, the American Psychiatric journal has case studies of opiate use for refractory Depression and in these cases they have had brilliant success with their patients. Again you must be so so careful and if heroin can be avoided then stay away from it.

    and finally…my heart goes out to all whom are suffering and please, there is a way to arrest this and you will find it if you look hard enough. i have Bipolar Disorder OCD & PTSD also an addictions disorder so I have to be very, very careful with the use of opiates but, I have had great success now for a prolonged period now a couple of years and the only way I have is from being honest with myself…

    I know it is tough but, “try” and stay grateful and look upon those whom are worse off than you and remember that the world, has much suffering and human beings always seem to come threw…Some spirituality does not hurt and push your self to do “anything ” positive, no matter how small…

    I wish you nothing but good luck and I can be reached at this address furtherfarthest@yahoo.ca please feel free to email me with any questions that includes Dr.’s and again…you must be VERY careful…and if you stay in the program, you will get your life back…i was literally immobilized for many years and lost up to 50 lbs from not being able to eat and i am here and i am HAPPY and STRONG…you can beat this…and last but least…

    get MAD not SAD…

    Reply
  • December 11, 2015 at 2:35 pm

    Dear reader

    I am from the Netherlands an interested in your research concerning TRD an buprenorphine.
    I am resistant for about 5 years. No medication helped me. I am on 50mg of parnate.
    I have no addiction history.
    My psych. is very liberal and we tried 0.4 mg (2x 0.2) of temgesic/ subutex a day.
    After 1 day i had 50% relief. A godsend. This lasted only 5 days and now i am in the place were i was.
    I understand the possible addiction, so i am now in a dilemma. Should i quit, wait longer, up my dose.
    This because every day contributes to the addiction and withdrawal i have to face when it is not working.

    I would appreciatie if you from your experience could give me some advice.

    The most people who have succes have that from the beginning and are not crashing within a week.
    So what are my chances if i continue?

    Could e.g. 1mg do the trick.
    I will give myself an honest chance but dont want up ending with a necessary withdrawel.
    Now after 2 weeks i still have a quick way out.

    Greeting,

    Reply
    • December 11, 2015 at 8:18 pm

      I’m sorry about your difficult situation. I don’t know the answer to your question, but I have a couple thoughts. Your description of your progress suggests that you had a benefit from the effects of buprenorphine that disappeared as you became tolerant to the mu-receptor effects of buprenorphine. You said that you took 0.4 mg per day— did you take it orally? Or sublingually? If you let it sit in your mouth, I would expect you to absorb about 20% of the dose…. And even less if you swallowed it. If you injected it, then it all entered your system. The ceiling effect occurs when people absorb about 1 mg per day, in my experience. To absorb 1 mg, a person has to put about 4 mg under the tongue, since 25% is absorbed by that route, on average.

      With all of that in mind, I would expect that a higher dose would give you relief from depression. But, I would also expect the same thing to happen as what happened before—i.e. the effect will only last a week or so, and then you will be even deeper into the tolerance problem.

      There is a debate whether the antidepressant effects of opioids are due to mu receptor activation, or from effects at kappa or other opioid receptors. The mu receptor shows tolerance, but the other receptors do not. Your experience suggests that mu receptors are involved, at least in YOUR type of depression—since the effects disappeared over the time course that tolerance develops.

      If I was you psychiatrist, I would stop at this point and drop the opioid approach. My fear would be that you would only become tolerant—and then the depression would return, but you would also have to deal with physical dependence on opioids. Understand that physical dependence is not ‘addiction’…. They are two completely different things. But both addiction and physical dependence can create problems—as I suspect you are aware.

      I’m sorry, and I wish I had a more optimistic opinion.

      Reply
  • August 21, 2016 at 12:01 am

    I began having intermittent depression episodes 10 years ago. I have been through the prescription of five different ssri’s and effexor as well. None worked and the side effects were not bearable not to mention I am in good health otherwise but was not about to give up healthy blood pressure for 160/95. The episodes have been gradually getting longer and more often. All I get is more suggestions for more exercise and diet which I am and have been doing all along. So , I asked the doctor for some pain relief for my arthritic knee and shoulder five years ago. He prescribed Tramadol and I take 50 mg 2x day. To this day it is the only thing I can depend on to lighten up the darker days. Tramadol is not prescribed nor designed for depression and I make no mention to my doctor about this because he may be lible and take me off of the only help I have. Instead I only refer to my arthritic knee of which the tramadol helps as well. But why must I hide the fact that it helps my depression. How many other patients hide the facts for fear of reprisal. On the other hand doctors have no problem advising me to take ibuprofen to kill my intestines and tylenol to kill my liver.

    Reply
    • August 21, 2016 at 3:11 pm

      I hear you. I’ve become frustrated over the years at the failure of many physicians to keep themselves educated regarding buprenorphine and other addiction treatments, especially given that overdose is now a leading cause of death in their younger patients! Doctors abandoned addiction treatment years ago– some people say it started in the very early 1900’s with the Harrison Act and the Supreme Court decision that upheld the law in the early 1920s. Whether it started then or not, physicians diagnosing addiction usually just refer patients away, with no knowledge of what will be done with them. When a treatment for heart disease has a success rate in the single digits, the state and Federal institutions that regulate medicine step in. But with addiction, treatments are not ‘medical’- at least not before the past decade– so there are no expectation for efficacy, and no punishments for sham treatments.

      Tramadol has two actions– a weak mu opioid effect plus norepinephrine reuptake, the latter similar to the effects of other NE reuptake blockers like Fetzima, or to a lesser extent effexor or cymbalta. If you have trouble getting tramadol at some point you may want to try one of those medications. The one caution with Tramadol is to avoid doses over 400 mg/day, as there is a real risk of seizures above that dose, especially if you also take antidepressants.

      Thanks for sharing!

      Reply
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