Eight-Milligram Single Dose of Buprenorphine as an Expeditious Treatment for Severe Suicidal Ideation: A Case Report

Abstract

Introduction: Buprenorphine is used to treat opioid use disorder and pain syndromes. This drug may be a suitable treatment choice for refractory depression, anxiety, self-injurious behaviors, and suicidal ideation. However, it has a significant abuse potential, which limits its use in suicidal patients with a history of substance abuse. Case Report: In this report, we present a case of chronic suicidal ideation due to substance-induced depressive disorder in a 25-yearold man from Noorabad, Fars, Iran. The patient was successfully treated with an 8-mg single dose of sublingual buprenorphine with minimal probability of diversion or misuse. We observed that 8 mg of buprenorphine exerted a rapid effect on the reduction and cessation of suicidal thoughts and depression. Conclusions: We demonstrated the antisuicidal effectiveness of a single dose of buprenorphine, which can be administered with minimum risk of diversion or misuse for suicidal patients with a history of substance abuse.

The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review

“…Regarding the efficacy of BUP on suicidal ideation, in addition to the Striebel report, two other studies were added—one randomized, double-blind, and placebo-controlled clinical trial [ 51 ], and one case report [ 52 ]—for a total of 90 patients having heterogeneous diagnoses (i.e., Borderline Personality Disorder, Major Depressive Disorder, Adjustment Disorders, Eating Disorders, Post-Traumatic Stress Disorder, Substance-Induced Depressive Disorder), but all with clinically significant suicidal ideation. Only one clinical case study about NSSI behavior was found [ 53 ]: it included 6 patients with self-injury behavior who were treated with BUP.…”

“…Three case-reports were included in this review: the studies of Striebel and Kalapatapu [ 47 ], Ahmadi et al [ 52 ], and Norelli et al [ 53 ]. Striebel and Kalapatapu [ 47 ] described the case of a 61-year old women affected by chronic-opiate dependent back pain and depression who was treated with 16 mg/4 mg of BUP/naloxone daily.…”

“…This drug combination was associated with no craving, managed her pain, and improved her mood, arresting suicidal ideation. Moreover, Ahmadi and colleagues [ 52 ] investigated a patient with suicidal ideation and substance-induced depression: the 25-year old man was successfully treated with a 8 mg single dose of sublingual BUP as an adjunctive treatment to olanzapine and valproate 20 and 400 mg daily doses, respectively. Furthermore, Norelli et al [ 53 ] described a case series including six psychiatric inpatients with severe, treatment refractory NSSI on which BUP has been administered—in different doses—in combination with other therapies (e.g., antipsychotic medications including clozapine, antidepressants, mood stabilizers including lithium, valproate, and carbamazepine, benzodiazepines, α-adrenergic and β-blockers, and the opiate antagonist naltrexone).…”

“…Unfortunately, a period of one week [41,44,46], or a few days more [52], may be not sufficient to observe the long-term efficacy or the emergence of some adverse effects related to this agent.…”

“…Importantly, Bodkin et al [ 42 ] and Nyhuis et al [ 46 ] reported some case reports regarding a complete remission with BUP. According to the studies of Striebel and Kalapatapu [ 47 ] and Ahmadi and colleagues [ 52 ], even considering that they are only clinical cases, a complete absence of suicidal ideation after BUP administration has been observed. Specifically, these effects were observed after one week of drug-treatment based on the study of Striebel and Kalapatapu [ 47 ], and after just few hours with a single BUP administration according to the Ahmadi and colleagues’ study [ 52 ].…”