Psychiatrists rx benzos all the time which is addictive as well. Adderall and Ritalin are Schedule II drugs like most pain killers.
I'm having trouble with the psychiatrists that do so. Benzos long term can worsen depression. On a non-biological level, it sometimes prevents patients from developing their own internal coping mechanisms. IMHO benzos only have justified use in assisting with taking down an agitated patient (along with haldol) & short term use with anxiety disorders (no more than a month, while waiting for the SSRI & CBT to kick in which takes about 1 month).
I also have had several patients who have become addicts thanks to their doctors. One PCP in my area is notoriously known to get his patients addicted.
Stimulants do have some documented (evidence based) benefit with depression. In fact with on rating scales for depression meet enough criteria to act as an antidepressant. The problem though is that its benefits (and I haven't reviewed the literature on this for over a year so I might be off a bit) go down with time (only a few weeks) and aren't considered good long term therapy. They however should be considered as adjunct therapy for treatment resistant depression.
As for narcotics-opioids, I haven't seen any good literature on it that trumps the existing standard of care and I did a pubmed search. So unless you know of some good data, if you do consider this as a form of treatment--you're using your patient as a guinea pig, and on top of that with a known drug of abuse. Add to the problem that several psyche patients already are at high risk for substance abuse or are in populations where there's often a primary gain to obtain such meds, e.g. if they don't use it themselves, they can sell it., then add on top of that--opioids can be used for suicide purposes.
Given the problems I mentioned, if you lack any good data, IMHO you're raising red flags for malpractice.
This is the only study I've seen with the use of suboxone (and close to Doc Samson)
http://opioids.com/buprenorphine/buprefdep.html
Interesting, but small patient population, and only 1 study. Not enough data IMHO to trump the standard of care.
Yeah opioids have been used to tx depression--in the 50s. That standard of care has long been elevated. You'd need some very good reasoning & documentation if you're going to use an opioid for depression. I can't think of one case I had so far where I'd consider it except for a case where the patient already had strong chronic pain, in which case the opioid would be used to tx the pain, and I wouldn't be the doctor handling that. I'd have their PCP do it.
but sometimes SSRIs don't work
Of course. SSRIs as with all antidepressants don't have good levels of efficacy.
If you are concerned with treatment resistant depression, there's several things you can do aside from SSRI use. In addition to psychotherapy, light therapy & excercise (all of which are well documented to work), fish oil 1 g PO Q daily (Omega fatty acid EPA), s-adenosyl methionine have been better documented to assist with treatment of depression and are not harmful, in fact have several health benefits to offer a patient, and can be used with our without antidepressant use. (If you're talking real bad depression, I'd use them with an antidepressant).
Then there's non-holistic pharm treatments that have been known to augment antidepressant tx: lithium & buspirone augmentation.
And with the SSRI, make sure you reached maximum dose with at least 4-6 weeks of therapy before you consider discontinuing it or adding another med. Consider use of a non SSRI.
Finally if several therapies do not work, there's ECT & Deep brain stimulation that can be considered. I'd be more open to that than opioid treatment.
And if the patient does have chronic pain in addition to depression, SNRIs and welbutrin have good documentation showing that they ease symptoms of chronic pain, but have the PCP treat the actual pain itself.
