Suboxone and Suicide

Today I came across an article about a study that showed a reduction in suicidal ideation caused by buprenorphine.  The dose of buprenorphine used in the study was lower than doses used for treating opioid dependence, ranging from 100-800 micrograms taken sublingually.   Buprenorphine was administered for up to four weeks in the study.

I haven’t read the full text yet, and I’ll have more to say after I do.  There was also a provocative link on the article’s web page leading to an editorial about treating depression with opioids.  My post is a bit premature, but I want readers to be the first to describe these findings at the water cooler tomorrow morning!

Most people reading this blog are already aware that opioids can elevate mood.  In fact, opioids can serve as an answer to all of life’s problems, making life fulfilling and pleasant… for a little while.    Those effects are part of why it is so hard to leave opioids behind.  Opioids bind to receptors for endorphins– called ‘mu opioid receptors’– and activate the same pathways that light up during life’s most pleasurable moments.

But most of the people reading this post have learned the sad, simple truth that the positive effects of opioids carry a steep cost.  Any pleasure provided from mu-receptor stimulation must be paid back by the absence of activity in those same pleasure pathways.  And like any transfer of energy, the process is not 100% efficient.  Most opioid users discover that they eventually lose far more happiness than they ever gained from opioids.

So my main question, when I see the full article, will be whether patients benefit from buprenorphine in the long run– or if they only get a respite from depression that must be paid back, with interest, after the medication is discontinued.  So far, the requirement for payback has been a fatal flaw in using opioids to treat mood disorders.

There are rare patients who do not respond to any treatments for depression, who receive a short respite from depressive symptoms from opioids.  I’ve considered using opioids in a few select, severely-depressed individuals.  But so far, I’ve decided that the potential cost– a lifetime dependence on opioids– is too great to justify the use of opioids for depressive disorders.  Here’s hoping that at some future date we’ll find a way to harness the benefits of opioids without the high cost of tolerance and dependence.