Opioids for treating depression

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations
  1. Jeffrey F. Scherrer, PhD1,2,3⇑,
  2. Joanne Salas, MPH1,2,
  3. Laurel A. Copeland, PhD4,5,6,
  4. Eileen M. Stock, PhD4,5,
  5. Brian K. Ahmedani, PhD7,
  6. Mark D. Sullivan, MD8,
  7. Thomas Burroughs, PhD3,
  8. F. David Schneider, MD, MSPH1,
  9. Kathleen K. Bucholz, PhD9 and
  10. Patrick J. Lustman, PhD9,10
+Author Affiliations

  1. [email protected]
Abstract
PURPOSE Recent results suggests the risk of a new onset of depression increases with longer duration of opioid analgesic use. It is unclear whether new-onset depression related to opioid analgesic use is a function of the dose prescribed or the duration of use or both.

METHODS Using a retrospective cohort design, we collected patient data from 2000 to 2012 from the Veterans Health Administration (VHA), and from 2003 to 2012 from both Baylor Scott & White Health (BSWH) and the Henry Ford Health System (HFHS). Patients (70,997 VHA patients, 13,777 BSWH patients, and 22,981 HFHS patients) were new opioid users, aged 18 to 80 years, without a diagnosis of depression at baseline. Opioid analgesic use duration was defined as 1 to 30, 31 to 90, and more than 90 days, and morphine equivalent dose (MED) was defined as 1 to 50 mg/d, 51 to 100 mg/d, and greater than 100 mg/d of analgesic. Pain and other potential confounders were controlled for by inverse probability of treatment–weighted propensity scores.

RESULTS New-onset depression after opioid analgesic use occurred in 12% of the VHA sample, 9% of the BSWH sample, and 11% of the HFHS sample. Compared with 1- to 30-day users, new-onset depression increased in those with longer opioid analgesic use. Risk of new-onset depression with 31 to 90 days of opioid analgesic use ranged from hazard ratio
= 1.18 (95% CI, 1.10–1.25) in VHA to HR = 1.33 (95% CI, 1.16–1.52) in HFHS; in opioid analgesic use of more than 90 days, it ranged from HR = 1.35 (95% CI, 1.26–1.44) in VHA to HR = 2.05 (95% CI, 1.75–2.40) in HFHS. Dose was not significantly associated with a new onset of depression.

CONCLUSIONS Opioid-related new onset of depression is associated with longer duration of use but not dose. Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression. Opioid analgesic use, not just pain, should be considered a potential source when patients report depressed mood.
 
Am J Psychiatry. 2016 May 1;173(5):499-508. doi: 10.1176/appi.ajp.2015.15070921. Epub 2016 Feb 12.
Opioid Modulation With Buprenorphine/Samidorphan as Adjunctive Treatment for Inadequate Response to Antidepressants: A Randomized Double-Blind Placebo-Controlled Trial.
Fava M1, Memisoglu A1, Thase ME1, Bodkin JA1, Trivedi MH1, de Somer M1, Du Y1, Leigh-Pemberton R1, DiPetrillo L1, Silverman B1, Ehrich E1.
Author information

Abstract
OBJECTIVE:
Major depressive disorder has been associated with dysregulation of the endogenous opioid system. The authors sought to determine whether opioid modulation achieved through administration of ALKS 5461, a combination of a μ- and κ-opioid partial agonist, buprenorphine, and a μ-opioid antagonist, samidorphan, would exhibit antidepressant activity in patients with majordepression.

METHOD:
A multicenter, randomized, double-blind, placebo-controlled, two-stage sequential parallel comparison design study was conducted in adults with major depression who had an inadequate response to one or two courses of antidepressant treatment. Participants were randomly assigned to receive adjunctive treatment with 2 mg/2 mg of buprenorphine/samidorphan (the 2/2 dosage group), 8 mg/8 mg of buprenorphine/samidorphan (the 8/8 dosage group), or placebo. Antidepressant effect was measured based on change from baseline to the end of 4 weeks of treatment on the 17-item Hamilton Depression Rating Scale (HAM-D), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Clinical Global Impressions severity scale (CGI-S).

RESULTS:
Compared with the placebo group, there were significantly greater improvements in the 2/2 dosage group across the threedepression outcome measures (HAM-D: -2.8, 95% CI=-5.1, -0.6; MADRS: -4.9, 95% CI=-8.2, -1.6; CGI-S: -0.5, 95% CI=-0.9, -0.1). There was also evidence of improvement in the 8/8 dosage group, although it did not achieve statistical significance. Overall, thebuprenorphine/samidorphan combinations were well tolerated, and there was no evidence of opioid withdrawal on treatment discontinuation.

CONCLUSIONS:
The buprenorphine/samidorphan combination is a novel and promising candidate for treatment of major depressive disorder in patients who have an inadequate response to standard antidepressants.

Am J Psychiatry. 2016 May 1;173(5):491-8. doi: 10.1176/appi.ajp.2015.15040535. Epub 2015 Dec 18.
Ultra-Low-Dose Buprenorphine as a Time-Limited Treatment for Severe Suicidal Ideation: A Randomized Controlled Trial.
Yovell Y1, Bar G1, Mashiah M1, Baruch Y1, Briskman I1, Asherov J1, Lotan A1, Rigbi A1, Panksepp J1.
Author information

Erratum in
Abstract
OBJECTIVE:
Suicidal ideation and behavior currently have no quick-acting pharmacological treatments that are suitable for independent outpatient use. Suicidality is linked to mental pain, which is modulated by the separation distress system through endogenous opioids. The authors tested the efficacy and safety of very low dosages of sublingual buprenorphine as a time-limited treatment for severe suicidal ideation.

METHOD:
This was a multisite randomized double-blind placebo-controlled trial of ultra-low-dose sublingual buprenorphine as an adjunctive treatment. Severely suicidal patients without substance abuse were randomly assigned to receive either buprenorphine or placebo (in a 2:1 ratio), in addition to their ongoing individual treatments. The primary outcome measure was change in suicidal ideation, as assessed by the Beck Suicide Ideation Scale at the end of each of 4 weeks of treatment.

RESULTS:
Patients who received ultra-low-dose buprenorphine (initial dosage, 0.1 mg once or twice daily; mean final dosage=0.44 mg/day; N=40) had a greater reduction in Beck Suicide Ideation Scale scores than patients who received placebo (N=22), both after 2 weeks (mean difference -4.3, 95% CI=-8.5, -0.2) and after 4 weeks (mean difference=-7.1, 95% CI=-12.0, -2.3). Concurrent use of antidepressants and a diagnosis of borderline personality disorder did not affect the response to buprenorphine. No withdrawal symptoms were reported after treatment discontinuation at the end of the trial.

CONCLUSIONS:
The time-limited, short-term use of very low dosages of sublingual buprenorphine was associated with decreased suicidal ideation in severely suicidal patients without substance abuse. Further research is needed to establish the efficacy, safety, dosing, and appropriate patient populations for this experimental treatment.
 
Members don't see this ad :)
You guys are both wrong. For refractory depression use Brintellix; it's a new 5HT agonist- basically ecstasy. An alternative is to use micro doses of ecstasy.

Of course you could also try 20 sessions of ECT in my surgery center :)
 
SpineBound said:
You guys are both wrong. For refractory depression use Brintellix; it's a new 5HT agonist- basically ecstasy. An alternative is to use micro doses of ecstasy.

Of course you could also try 20 sessions of ECT in my surgery center :)
Click to expand...
is it really that similar to ecstasy? I thought that ecstasy also has major effects on dopamine, which brintellix doesn't. Also brintellix causese sexual dysfunction, but less than SSRIs, while ecstasy actually enhances sex.
 
bedrock said:
is it really that similar to ecstasy? I thought that ecstasy also has major effects on dopamine, which brintellix doesn't. Also brintellix causese sexual dysfunction, but less than SSRIs, while ecstasy actually enhances sex.
Click to expand...

bedrock seems to have a lot of insider information here.....
 
  • Like
Reactions: 1 user
Guys c'mon you're so behind the times... it's now called Trintellix. Sheeeesh ;) And is it that much better than any of the SSRIs, really?
 
  • Like
Reactions: 1 user
I'm a Psych resident and I can safely say that Brintellix/Trintellix is definitly not superior to SSRI/SNRI for depression. They are all 33% effective (SSRI/SNRI/Mirtazapine/Bupropion). STAR-D is the big trial that looked at this few years ago.
 
  • Like
Reactions: 1 user
101N said:
Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations
  1. Jeffrey F. Scherrer, PhD1,2,3⇑,
  2. Joanne Salas, MPH1,2,
  3. Laurel A. Copeland, PhD4,5,6,
  4. Eileen M. Stock, PhD4,5,
  5. Brian K. Ahmedani, PhD7,
  6. Mark D. Sullivan, MD8,
  7. Thomas Burroughs, PhD3,
  8. F. David Schneider, MD, MSPH1,
  9. Kathleen K. Bucholz, PhD9 and
  10. Patrick J. Lustman, PhD9,10
+Author Affiliations

  1. [email protected]
Abstract
PURPOSE Recent results suggests the risk of a new onset of depression increases with longer duration of opioid analgesic use. It is unclear whether new-onset depression related to opioid analgesic use is a function of the dose prescribed or the duration of use or both.

METHODS Using a retrospective cohort design, we collected patient data from 2000 to 2012 from the Veterans Health Administration (VHA), and from 2003 to 2012 from both Baylor Scott & White Health (BSWH) and the Henry Ford Health System (HFHS). Patients (70,997 VHA patients, 13,777 BSWH patients, and 22,981 HFHS patients) were new opioid users, aged 18 to 80 years, without a diagnosis of depression at baseline. Opioid analgesic use duration was defined as 1 to 30, 31 to 90, and more than 90 days, and morphine equivalent dose (MED) was defined as 1 to 50 mg/d, 51 to 100 mg/d, and greater than 100 mg/d of analgesic. Pain and other potential confounders were controlled for by inverse probability of treatment–weighted propensity scores.

RESULTS New-onset depression after opioid analgesic use occurred in 12% of the VHA sample, 9% of the BSWH sample, and 11% of the HFHS sample. Compared with 1- to 30-day users, new-onset depression increased in those with longer opioid analgesic use. Risk of new-onset depression with 31 to 90 days of opioid analgesic use ranged from hazard ratio
= 1.18 (95% CI, 1.10–1.25) in VHA to HR = 1.33 (95% CI, 1.16–1.52) in HFHS; in opioid analgesic use of more than 90 days, it ranged from HR = 1.35 (95% CI, 1.26–1.44) in VHA to HR = 2.05 (95% CI, 1.75–2.40) in HFHS. Dose was not significantly associated with a new onset of depression.

CONCLUSIONS Opioid-related new onset of depression is associated with longer duration of use but not dose. Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression. Opioid analgesic use, not just pain, should be considered a potential source when patients report depressed mood.
Click to expand...




Actually, the biggest "risk factor" for increased "depression and suicide risk" are ANTIDEPRESSANT MEDS in the first place:

https://www.newscientist.com/articl...sants-dont-work-well-why-are-they-so-popular/

Interesting how big pharma tried to cover up the increased suicide rates, particularly in teenagers given these drugs.
 
101N said:
Prescription Opioid Duration, Dose, and Increased Risk of Depression in 3 Large Patient Populations
  1. Jeffrey F. Scherrer, PhD1,2,3⇑,
  2. Joanne Salas, MPH1,2,
  3. Laurel A. Copeland, PhD4,5,6,
  4. Eileen M. Stock, PhD4,5,
  5. Brian K. Ahmedani, PhD7,
  6. Mark D. Sullivan, MD8,
  7. Thomas Burroughs, PhD3,
  8. F. David Schneider, MD, MSPH1,
  9. Kathleen K. Bucholz, PhD9 and
  10. Patrick J. Lustman, PhD9,10
+Author Affiliations

  1. [email protected]
Abstract
PURPOSE Recent results suggests the risk of a new onset of depression increases with longer duration of opioid analgesic use. It is unclear whether new-onset depression related to opioid analgesic use is a function of the dose prescribed or the duration of use or both.

METHODS Using a retrospective cohort design, we collected patient data from 2000 to 2012 from the Veterans Health Administration (VHA), and from 2003 to 2012 from both Baylor Scott & White Health (BSWH) and the Henry Ford Health System (HFHS). Patients (70,997 VHA patients, 13,777 BSWH patients, and 22,981 HFHS patients) were new opioid users, aged 18 to 80 years, without a diagnosis of depression at baseline. Opioid analgesic use duration was defined as 1 to 30, 31 to 90, and more than 90 days, and morphine equivalent dose (MED) was defined as 1 to 50 mg/d, 51 to 100 mg/d, and greater than 100 mg/d of analgesic. Pain and other potential confounders were controlled for by inverse probability of treatment–weighted propensity scores.

RESULTS New-onset depression after opioid analgesic use occurred in 12% of the VHA sample, 9% of the BSWH sample, and 11% of the HFHS sample. Compared with 1- to 30-day users, new-onset depression increased in those with longer opioid analgesic use. Risk of new-onset depression with 31 to 90 days of opioid analgesic use ranged from hazard ratio
= 1.18 (95% CI, 1.10–1.25) in VHA to HR = 1.33 (95% CI, 1.16–1.52) in HFHS; in opioid analgesic use of more than 90 days, it ranged from HR = 1.35 (95% CI, 1.26–1.44) in VHA to HR = 2.05 (95% CI, 1.75–2.40) in HFHS. Dose was not significantly associated with a new onset of depression.

CONCLUSIONS Opioid-related new onset of depression is associated with longer duration of use but not dose. Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression. Opioid analgesic use, not just pain, should be considered a potential source when patients report depressed mood.
Click to expand...




Here is GSK covering up information about increased suicide risk with these drugs:

http://ahrp.org/gsk-reverses-decade-of-denial-paxil-triggered-suicide-in-adults/
 

Attachments

  • LyricaAdvertising.png
    LyricaAdvertising.png
    149.8 KB · Views: 52
Last edited:
  • Like
Reactions: 1 user
You must log in or register to reply here.
Next unread thread

Similar threads

lobelsteve
SCS for depression being studied
Replies
5
Views
589
drusso
drusso
T
Treating back pain in the ER
Replies
43
Views
2K
mdo1738
M
TheLoneWolf
Buprenorphine for Chronic Pain, Not Full Agonist Opioids, New VA Guidance Says
Replies
13
Views
2K
kstarm
K
K
Opioids until....
Replies
11
Views
1K
MitchLevi
MitchLevi
TheLoneWolf
Opioid Agonist Therapy Underused, Data Suggest
Replies
27
Views
2K
Pain Applicant1
Pain Applicant1
Top