Kratom use for depression/anxiety self-management: challenges during the COVID-19 pandemic – A case report

Abstract

Background: Kratom is a psychoactive plant preparation originating from Southeast Asia. It has been used as a recreational and performance drug in Southeast Asia, and is now increasingly used in Europe and the U.S. Case report: We describe the case of a 63-year-old man who presented for treatment after his long-term Kratom use failed as a self-management for persistent major depression (ICD 10: F33.2) and a generalized anxiety disorder (ICD-10: F41.1). The failure coincided with emerging stress at the beginning of the COVID-19 pandemic. The patient suffered from childhood on from ruminative thinking and depressive mood, which was treated in several settings during his life. He started to use alcohol to control his depression, but developed an alcohol addiction. This was successfully treated and the patient remained abstinent for more than 25 years afterwards. About 7 years ago, he started to use Kratom 3-4 times daily on a regular, but constant rate. Kratom use worked efficiently as a self-management of his depression with no escalation of dosing. It was also very effective in reducing Morbus Meni ere symptoms of tinnitus and sudden hearing loss, which eventually allowed regular performance as a caregiver in a demanding job on shift-work. During recently increased stress load in the work environment and the COVID-19 pandemic, the established Kratom doses failed to control hyperarousal and mental nervousness. The patient was treatment seeking and subsequently detoxified from Kratom. Anxiety-and depression management was shifted to treatment attempts with Lorazepam, Venlafaxine, Opipramol, Mirtazapine and psychotherapy. Conclusion: Kratom instrumentalization for self-management of depression and anxiety may effectively work without causing escalation of drug use and addiction, but may be limited by a temporary increase in psychological stress load and a relapse into major depression and generalized anxiety disorder.

Kratom (Mitragyna speciosa): eine psychoaktive Pflanze mit Chancen und Risiken

“…Eine vergleichbare Prävalenz für den Konsum von Kratom von 0,7 % (und eine deutlich höherer Prävalenz von 10,4 % bei Personen mit Opi oidgebrauchsstörungen) wurde in den USA im Rahmen einer für Intoxikationen zeigte einen durchschnittlich schwereren klinischen Schweregrad von In toxikationen mit Kratom in den USA im Vergleich mit Thailand[33].Daten zur Prävalenz des Konsums von Kratom in Deutschland sind nicht verfügbar. Es gibt jedoch in Deutschland einen diversifi zierten Markt für kratomhaltige Produkte 2 und einzelne Fallberich te aus Deutschland über die Eigenbehandlung von psychischen[34] und Schmerzstörungen[35] mit Kratom. Besitz und Konsum von Kratom in Deutschland legal und Kratom fällt weder unter das Betäubungs mittelgesetz (BtMG) noch unter das Arzneimittelgesetz (AMG).…”

Methadone, Buprenorphine, and Clonidine Attenuate Mitragynine Withdrawal in Rats

“…A widely held view is that kratom is not as risky as opioid drugs and that the danger can be outweighed by the potential benefits ( Prozialeck, 2016 ). However, aggressive kratom consumption pattern may cause escalation of consumption and more severe withdrawal signs ( Müller et al, 2021 ). Indeed, withdrawal periods are highly aversive, which makes it hard for an individual to maintain abstinence ( Swogger and Walsh, 2018 ).…”

Adverse Psychological and Therapeutic Effects of Kratom (Mitragyna speciosa) Use: A Systematic Review

“…The major mental health drawback of kratom use as a therapeutic agent is its addictive potential, characterized by its association with development of withdrawal symptoms and craving on abstinence, tolerance and cross-tolerance, and the risk of developing kratomrelated substance use disorder (16,17,19,20,22,29,(32)(33)(34)(35)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58).…”