Antimanic, Antidepressant, and Antipanic Effects of Opiates: Clinical, Neuroanatomical, and Biochemical Evidence

Abstract

These clinical data may offer some support for the hypothesis that opiates have antidepressant, antimanic, and antipanic effects. This hypothesis should be studied directly by double-blind studies of the effects of exogenous and synthetic endogenous opioid peptides in patients with major depressive illness, panic and anxiety states, schizophrenia, and schizo-affective illness. These clinical data support our studies in nonhuman primates and man which suggest a common LC or NE hyperactivity may underly both drug withdrawal and spontaneous panic states. Whether endorphin deficiency or derangements account for the postulated NE hyperactivity needs additional study and we will discuss our preliminary work later. Failure of endorphins to terminate bursts in LC firing rate and NE release may be responsible for both of these types of panic states. In addicts, this mechanism could exist prior to opiate use, or abuse of potent exogenous endorphinomentic compound may cause an endorphin-abnormality. Both of these possibilities would be compensated by continuous opiate maintenance. Methadone maintenance is a complicated psychiatric, psychological, and social phenomenon. Further studies are necessary to evaluate the role of opiate maintenance in treating or suppressing the emergence of underlying psychopathology. Previous psychiatric hospitalization or treatment for a schizophrenic or affective illness may contraindicate absolutely the use of clonidine or other rapid detoxification methods. These data suggest the possibility of substituting a nonaddicting psychotropic medication for opiates in some patients who are self-medicators. The clinical data support other data suggesting the potential antipsychotic, antidepressant, and antianxiety/antipanic effects of the endogenous opioids, endorphins, and exogenous opioids, endorphins, and exogenous opiates. These and other data suggest potential utility for opioid agonists and endorphin testing in psychiatric treatment and diagnosis.

Distinct Roles of Opioid and Dopamine Systems in Lateral Hypothalamic Intracranial Self-Stimulation

“…Numerous clinical observations support the involvement of the opioid system in the morbidity of depression (Verebey et al, 1978; Gold et al, 1982). Animal studies have shown that acute morphine administration increases immobility in the forced swim test (Amir, 1982; Zurita and Molina, 1999) and water wheel test (Kastin et al, 1984).…”

Differentiating Between the Course of Illness in Bipolar 1 and Chronic-Psychotic Heroin-Dependent Patients at Their First Agonist Opioid Treatment

“…Methadone maintenance has been observed to achieve major mood stabilization in bipolar 1 patients; this supports the idea that opioid agonists may display an antimanic effect. 15,42,43,70,71 The fact is that, contrary to PSYc pairs, BIP1 patients who use street opioids, beyond the effect on their psychopathology, show a faster and more severe progression of their addictive disease. Even in this case, however, the fast kinetics of street opioids could explain a biphasic action on patients' concomitant psychopathology: initially favorable, and then no longer effective.…”

The impact of mood symptomatology on pattern of substance use among homeless

“…A later study found that cyclothymia, and to a lesser extent irritable traits could represent the temperamental profile of heroin addicts Maremmani et al, 2009). In the last decade the impact of opioids on psychopathology has been investigated (Comfort, 1977;Emrich et al, 1982;Gold et al, 1982;Maremmani et al, 2014b) and although results cannot rule out the possibility that bipolar heroin addicts use heroin in a self-therapeutic manner, any initial beneficial effect exerted by the substance on emotional instability would soon be followed by a mood-destabilizing action, which would accelerate the course of the illness and ultimately lead to a worse clinical presentation, both on the addictive and psychopathological plane . The link between bipolarity and substance abuse is still an open and unclear issue.…”