Addictive potential of novel treatments for refractory depression and anxiety

Abstract

Treatment-resistant mood disorders and anxiety disorders require intensive treatment, but treatment options should balance benefits and adverse effects or other potential detrimental effects on patients, including the risk of developing prescription medication addiction. Some of the newer treatment modalities for mood and anxiety disorders may have similar properties to benzodiazepines. The goal of this review was to identify the potential for developing dependence on the novel treatment approaches to treatment-resistant depression and refractory anxiety disorders. PubMed, MEDLINE, PsycINFO, Ovid, Cochrane Library, and Google Scholar were searched. Ketamine is effective in improving symptoms of major depressive disorder, but with no sustained benefits. Long-term use of oral or intranasal ketamine formulations may be associated with the risk of developing dependence. Augmentation of stimulant medication is usually effective for residual symptoms of depression, but the effects are usually short lasting and there is a potential for abuse. Synthetic cannabinoids and medicinal cannabis are increasingly being prescribed for a number of medical conditions, including anxiety disorders, without enough evidence about their efficacy and with the risk of patients developing dependence. In summary, benzodiazepines, ketamine, stimulant medications, and cannabinoids have some common characteristics, including short-lasting benefits and the risk of developing prescription medication addiction with longer use. All of these treatments may raise ethical dilemmas about the appropriateness of prescribing these medications in the long run for patients with depression and anxiety disorders.

Early life stress and development of the endocannabinoid system: A bidirectional process in programming future coping

“…Beyond the 5‐HT1A receptor, several additional mechanisms have been proposed for mediating CBD effects on anxiety, among which are fatty‐acid amid‐hydrolase (FAAH) inhibition, COX‐2 inhibition, and TRPV1 blockade (Patel et al, 2017). In contrast to several positive reports (Bergamaschi et al, 2011; Crippa et al, 2011), however, a systematic review and meta‐analysis failed to find an anxiolytic effect of cannabinoids (Kolar, 2018; Whiting et al, 2015).…”

Transcranial Direct Current Stimulation for Treatment-Resistant Major Depression: A Double-Blind Randomized Sham-Controlled Trial

“…Some medications including benzodiazepines, ketamine, stimulant medications, and cannabinoids provide short-lasting benefits and increase the risk of addiction in the long term. 4 Electroconvulsive therapy offers more long-lasting symptom relief; however, technical challenges and the expense prevent it being as the first-line treatment in daily care. 5 In recent years, there has been growing interest in applying transcranial direct current stimulation (tDCS) for treatment of depression.…”

Alertness in patients with treatment-resistant depression: interface between sleep medicine and psychiatry—review article

“…We should be careful with overusing stimulant medications as just cognitive enhancers because of its addictive potential and lack of sustained benefits [38] and limit the usage of this class of medication only for patients with residual symptoms of depression, such as decreased alertness, poor concentration, and resulting in poor work performance.…”