The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: a randomized, double-blind, clinical trial

Ahmadi, Jamshid; Jahromi, Mina Sefidfard; Ehsaei, Zahra

doi:10.1186/s13063-018-2843-9

Cited by 37 publications

(26 citation statements)

References 33 publications

(16 reference statements)

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“…Evidence for BPNʼs direct antisuicidal and mood‐stabilizing effects are just beginning to emerge; this has been shown in the reduction of suicidal ideation in both time‐limited ultra‐low doses of 0.1 to 0.5 mg BPN 13 as well as in single administration of high doses of 32 to 96 mg BPN 14 . Further investigation over this large range of doses and the relative µ‐opioid and κ‐opioid receptor occupancy levels may inform mechanistic hypotheses distinguishing the antisuicidal properties of the compound.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Buprenorphine—A Treatment for Psychological Pain and Suicidal Ideation?

2020

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Background and Objectives: Buprenorphine is commonly used to manage opioid use disorder; however, the literature describes its potential role in treating treatment-resistant depression. Methods: We present a patient with bipolar disorder and opioid use disorder, who presented status post-suicide attempt. Results: After initiating buprenorphine-naloxone, the patient reported rapid improvement in depressive symptoms, pain, and suicidal ideation. Discussion and Conclusions: This case demonstrates buprenorphineʼs antisuicidal and mood-stabilizing capabilities, potentially via antagonizing κ-opioid receptors as well as reinstating the balance between reward and antireward circuitry. Scientific Significance: This case highlights buprenorphinenaloxone as a treatment for both treatment-resistant depression and opioid use disorder, as well as buprenorphineʼs rapid antidepressant, analgesic, and antisuicidal effects.

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Section: Discussionmentioning

confidence: 99%

Case Report: Buprenorphine—A Treatment for Psychological Pain and Suicidal Ideation?

2020

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“…Buprenorphine was well tolerated. Similarly, a 3-day study of men with depression and opioid use disorder also demonstrated decreases in suicidal ideation after a large dose of sub-lingual buprenorphine, although this trial was not placebo controlled 329 . Larger studies are needed to replicate the finding that opioids may improve suicidal ideation, and this is an observation that comports with the hypothesis that psychic pain is an important determinant of suicide risk 330 .…”

Section: [H3] Safety Planning Intervention or Crisis Response Planninmentioning

confidence: 97%

Suicide and suicide risk

Turecki

Brent²,

Gunnell

et al. 2019

Nat Rev Dis Primers

604

473

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Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries, such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual's risk of suicide is challenging. Improving risk assessment, for example using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths, and current efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) and coordinated social and public health initiatives, should continue to improve the management of suicidal patients and decrease suicide-associated morbidity. [H1] Epidemiology Based on self-report survey data, the WHO has estimated that for every death by suicide ~20 people make suicide attempts 1. This ratio varies from country to country depending on the lethality of commonly used suicide methods. In all countries, the incidence of suicide attempts is highest in individuals 15-24 years of age. By comparison, the lowest rates of suicide is observed amongst young people <15 years of age, with the highest generally observed in people >75 years of age 1. However, the age-groups with the highest incidence at other ages vary from region to region; for example, in a 25

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“…Suicidal ideation is one of the more severe symptoms that can occur with MDD and TRD. Two studies (Ahmadi, Jahromi, & Ehsaei, 2018; Striebel & Kalapatapu, 2014) reported that suicidal thoughts completely ceased and depression symptoms improved in two patients treated with buprenorphine. However, in one study the patient was opioid dependent and in the other the depression was substance-induced.…”

Section: Buprenorphine and Suicidal Ideationmentioning

confidence: 99%

Buprenorphine: prospective novel therapy for depression and PTSD

Madison

Eitan

2020

Psychol. Med.

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BackgroundDepression and post-traumatic stress disorder (PTSD) are leading causes of disability and loss of life by suicide. Currently, there are less than satisfactory medical solutions to treat these mental disorders. Here, we explore recent preclinical and clinical studies demonstrating the potential of using buprenorphine to treat major depressive disorder, treatment-resistant depression, and PTSD.MethodBibliographic databases were searched to include preclinical and clinical studies demonstrating the therapeutic potential of buprenorphine and the involvement of the kappa opioid receptor (KOR) in mediating these effects.ResultsOriginal clinical studies examining the effectiveness of buprenorphine to treat depression were mixed. The majority of participants in the PTSD studies were males and suffer from chronic pain and/or substance use disorders. Nonetheless, these recent studies and analyses established proof of concept warranting farther investigations. Additionally, KOR likely mediates the antidepressant and some of the anxiolytic effects of buprenorphine. Still, it appears that the full spectrum of buprenorphine's beneficial effects might be due to activity at other opioid receptors as well.ConclusionsPharmaceuticals' abilities to treat medical conditions directly relates to their ability to act upon the endogenous biological systems related to the conditions. Thus, these recent findings are likely a reflection of the central role that the endogenous opioid system has in these mental illnesses. Further studies are necessary to study the involvement of endogenous opioid systems, and specifically KOR, in mediating buprenorphine's beneficial effects and the ability to treat these medical conditions while minimizing risks for misuse and diversion.

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The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: a randomized, double-blind, clinical trial

Cited by 37 publications

References 33 publications

Case Report: Buprenorphine—A Treatment for Psychological Pain and Suicidal Ideation?

Case Report: Buprenorphine—A Treatment for Psychological Pain and Suicidal Ideation?

Suicide and suicide risk

Buprenorphine: prospective novel therapy for depression and PTSD

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