Buprenorphine as a Treatment for Major Depression and Opioid Use Disorder.

Amanda B Namchuk,Irwin Lucki,Caroline A Browne

doi:10.3389/adar.2022.10254

Abstract

Rates of major depressive disorder (MDD) are disproportionally high in subjects with opioid use disorder (OUD) relative to the general population. MDD is often more severe in OUD patients, leading to compliance issues with maintenance therapies and poor outcomes. A growing body of literature suggests that endogenous opioid system dysregulation may play a role in the emergence of MDD. Buprenorphine, a mixed opioid receptor agonist/antagonist approved for the treatment of OUD and chronic pain, may have potential as a novel therapeutic for MDD, especially for patients with a dual diagnosis of MDD and OUD. This paper presents a comprehensive review of papers relevant to the assessment of buprenorphine as a treatment for MDD, OUD, and/or suicide compiled using electronic databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The principal goal of this literature review was to compile the clinical studies that have interrogated the antidepressant activity of buprenorphine in opioid naïve MDD patients and OUD patients with comorbid MDD. Evidence supporting buprenorphine's superiority over methadone for treating comorbid OUD and MDD was also considered. Finally, recent evidence for the ability of buprenorphine to alleviate suicidal ideation in both opioid-naïve patients and opioid-experienced patients was evaluated. Synthesizing all of this information, buprenorphine emerges as a potentially effective therapeutic for the dual purposes of treating MDD and OUD.

Highlights

In the late 1990s, pharmaceutical companies began marketing opioid analgesics to physicians as safe and non-addictive, but essential for quality patient care
The electronic database searches for relevant clinical studies/trials were supplemented with manual searches for published, unpublished, and ongoing trials in ClinicalTrials.gov using the search terms “major depressive disorder” or “substance use disorder” combined with “buprenorphine.”
The studies discussed in this review tell a cohesive story: buprenorphine is an effective and safe antidepressant

Summary

Introduction

In the late 1990s, pharmaceutical companies began marketing opioid analgesics to physicians as safe and non-addictive, but essential for quality patient care. Blood pressure, respiratory rate, and heart rate as “the fifth vital sign” as doctors started to consistently prescribe opioid analgesics for acute and chronic pain [1]. The consequent rise in prescription opioid use has been linked directly to an initial increase of overdose deaths starting in 1999 [2]. As many opioid-dependent patients were forced to seek alternative nonprescription methods to access opioids, the rate of heroin use increased leading to a resurgence in deaths from opioid overdose [3]. In 2013, dealers began to cut heroin and other drugs with the potent synthetic opioid fentanyl and deaths from opioid overdose spiked yet again [4]. Three million US citizens have suffered or are currently suffering from opioid use disorder (OUD) [5], spurred

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