Psychotherapeutic Benefits of Opioid Agonist Therapy

Abstract

Opioids have been used for centuries to treat a variety of psychiatric conditions with much success. The so-called "opium cure" lost popularity in the early 1950s with the development of non-addictive tricyclic antidepressants and monoamine oxidase inhibitors. Nonetheless, recent literature supports the potent role of methadone, buprenorphine, tramadol, morphine, and other opioids as effective, durable, and rapid therapeutic agents for anxiety and depression. This article reviews the medical literature on the treatment of psychiatric disorders with opioids (notably, methadone and buprenorphine) in both the non-opioid-dependent population and in the opioid-dependent methadone maintenance population. The most recent neurotransmitter theories on the origin of depression and anxiety will be reviewed, including current information on the role of serotonin, N-Methyl d-Aspartate, glutamate, cortisol, catecholamine, and dopamine in psychiatric disorders. The observation that methadone maintenance patients with co-existing psychiatric morbidity (so called dual diagnosis patients) require substantially higher methadone dosages by between 20% and 50% will be explored and qualified. The role of methadone and other opioids as beneficial psychiatric medications that are independent of their drug abuse mitigating properties will be discussed. The mechanisms by which methadone and other opioids can favorably modulate the neurotransmitter systems controlling mood will also be discussed.

Increased anxiety-like behaviors in rats experiencing chronic inflammatory pain

“…However, most publications seem to agree on the general anxiolytic status of morphine. In fact, morphine has already been shown to decrease fear-and anxiety-related behaviors in rhesus monkeys [59] and in humans [60]. Furthermore, injection of morphine in healthy rats either has no effect [26] or induces anxiolytic effects [61,62] when tested in the EPM.…”

Depression and Prescription Opioid Misuse Among Chronic Opioid Therapy Recipients With No History of Substance Abuse

“…Historically, opioids have been used to treat psychological distress (mania and melancholia), as well as physical pain, 32,33 and more recently studies have suggested using opioids for treatment-resistant depression and anxiety. [34][35][36][37] It is also possible that depressed patients may experience their pain as more severe, which may prompt misuse. 38 A recent study of elderly adults supports the association of current depressive symptoms and opioid misuse.…”

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

“…Despite this comorbidity there is evidence that such patients do well in opioid treatment and certainly no worse than non-depressed patients (Ngo et al, 2011;) (III). Higher doses may be needed for methadone-maintained patients with depression, and enrolment and stabilisation in such programmes alone is likely to have a beneficial effect on their psychiatric symptoms (Tenore, 2008) (IV). This may be a direct effect of opioid agonism on the reward pathway as well as secondary consequences on their chaotic lifestyle.…”