Here we go again: Are Opioids the Next Antidepressant?

[pastafan]

http://www.nytimes.com/2016/06/05/o...oids-the-next-antidepressant.html?ref=opinion

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[Ducttape]

the psychiatrist is making the classic mistake - that a patient says his/her level of functioning was better in the remote past when on narcotics. when patients emphatically state this and i decide to take the time, 90% of the time, these same individuals were unemployed, were undergoing or had become divorced/estranged, were no different in terms of activity level, and had similar levels of pain, back at that glorious time.

(fyi, about 10% of the patients that ive asked were pathological liars)

 

[drusso]

psychiatrists have been using opioids for depression since the 1800's.

http://www.ncbi.nlm.nih.gov/pubmed/3153713

 

[Extralong]

Wtf. Opioids for depression.Wtf!! Nope, absolutely not. I'm so furious, and bewildered I cannot ever use complete sentences.

The discussion in that article is very simplified, not scientific, and last, but not least, giving borderline patients controlled substances is a terrible idea, I repeat, terrible terrible idea.

It's like saying diabetes is bad for you, but at least you are not starving to death from lack of food, so it's okay, eat more food no matter how unhealthy it is.

 

[Extralong]

This gives patients another damn reason to request opioids. Arrg.

 

[emd123]

Like Drusso mentioned above, opiates have been used at one time for depression (and just about everything else) in the past, until the catastrophic effects were noted, and doctors wised up and started to back off, like we are again starting (hopefully) to see now with chronic non-cancer pain and opiates. If you don't learn from history, it just repeats itself. This keeps happening with opiates, over and over again. To re-introduce opiates for depression would be catastrophic. That being said, if we as medical profession are stupid enough to let this happen without standing up and saying "Hell no!" I suppose it'll just give me a reason to say patients have to go elsewhere, i.e. to a psychiatrist, to get their opiates. Hopefully, we're smart enough, and ethical enough, to not let it go there.

 

[Ducttape]

http://www.ncbi.nlm.nih.gov/pubmed/10334373

Physician substance use by medical specialty.
Hughes PH1, Storr CL, Brandenburg NA, Baldwin DC Jr, Anthony JC, Sheehan DV.
Author information
Abstract
Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance abuse and dependence were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence.

 

[vistaril]

As a psychiatrist, I wasn't sure whether to laugh or cry after reading the article. Regardless, it's embarrassing.

 

[101N]

The mu receptor system is involved in all kinds of stuff beyond nociceptive pain: maternal fetal bonding, separation anxiety, depression,
PTSD, etc.