I’ve recently been researching buprenorphine for treatment-resistant depression (TRD). My psychiatrist prescribed it yesterday. I’m in a temporary remission right now, but will begin to relapse (like clockwork) in a few days, at which point I’ll start the medication.
Since I will be taking buprenorphine solely for TRD, my doctor did not have to register or obtain a waiver. Under 21 U.S.C. § 823(g), practitioners must register or obtain a waiver from the Substance Abuse and Mental Health Services Administration only if dispensing narcotic drugs “to individuals for maintenance treatment or detoxification treatment.”
Here’s my own informal summary of the published studies/reports about buprenorphine for TRD. Many of them don’t have abstracts. If anyone wants the full studies, just send me an email: awmurawski(at sign)gmail(dot com).
Nyhuis PW, Gastpar M, Scherbaum N. Opiate treatment in depression refractory to antidepressants and electroconvulsive therapy. J Clin Psychopharmacol. 2008 Oct;28(5):593-5
Study included six patients – one week period.
Patients received sublingual buprenorphine as monotherapy in a final dosage of 0.8 to 2.0 mg once daily, beginning with 0.4 mg/d and with successive increases every 1 to 2 days.
Five of 6 patients reached complete remission according to the HAMD score (maximal score, 8 points; physician’s rating) and 4 of 6 according to the BDI (maximal score, 12 points; self-rating).
Nyhuis, P.W., Specka, M. & Gastpar, M. Does the antidepressive response to opiate treatment describe a subtype of depression? European Neuropsychopharmacology 16(suppl. 4), S309 (2006).
Eleven patients – one week period
Then the patients were administered buprenorphine as monotherapy in a final dosage
of 0.8−2.0 mg once daily.
Seven patients responded with a decrease in HAMD and BDI scores of at least 50%.
Callaway E. Buprenorphine for depression: the un-adoptable orphan. Biol Psychiatry. 1996 Jun 15;39(12):989-90.
The author has treated five patients with buprenorhine, with “impressive” results. All five patients were followed for several years, during which “good results were maintained.” No rating scale data is included to assess level of depression before and after initiating treatment.
“Buprenorphine [BPN] in low (circa 0.3 mg qid) transmucosally (under the tongue or by nose drops) can be dramatically effective in cases of treatment for refractory depression.”
Bodkin JA, Zornberg GL, Lukas SE, Cole JO. Buprenorphine treatment of refractory depression. J Clin Psychopharmacol. 1995 Feb;15(1):49-57.
Ten patients – most over six weeks; some followed longer. Trial period was 6 weeks.
Buprenorphine was initiated at 0.15 mg every morning, intranasally or sublingually. We used the preparation of buprenorphine hydrochloride solution currently marketed in the United States for parenteral administration. This comes in small ampules containing 0.3 mg of the drug in 1 ml of aqueous solution. Dosage was titrated according to tolerance and clinical benefit, with a maximum daily dosage of 1.8 mg.
Three patients unable to tolerate more than two doses.
The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression.
Three of these remaining seven dropped out at 4 weeks due to side effects, despite dramatic improvement in depression. One of these four improved dramatically during week one, but then relapsed (patient #5)
Two of the remaining four contacted authors at two year point. Doing well. One of them was taking 0.3 mg 3 x daily plus 0.45 mg at bedtime (patient #1). The other was taking 3.3 mg daily (patient #2).
The third of the remaining four did well for six months taking 0.6 mg sublingually 3 x daily. But he relapsed when his outpatient assistance program tried to mobilize him back to full employment, and his father reduced financial assistance. (Patient #3).
The fourth of the remaining four did well for eight weeks, but then relapsed. Her buprenorphine dosage was systematically increased every few days up to a total of 3.6 mg/day, with no benefit.
Mongan L, Callaway E. Buprenorphine responders. Biol Psychiatry. 1990 Dec 15;28(12):1078-80.
Twelve subjects. Response measured on a short mood scale over 2½ hours, and in follow-up interviews the next day.
Subjects were given 1.5 mg buprenorphine sublingually. If no response was noted within 45 minutes, they were given another 1.5 mg.
Eleven were psychiatric inpatients, veterans and most had served in Vietnam. DSM-III-R diagnoses included major depression, schizophrenia, borderline personality, PTSD and bipolar-affective disorder. Most had multiple diagnoses combining one or more of the
above with adjustment, panic or impulse control disorder. The twelfth subject was a normal staff member.
Eight of the subjects had diagnoses including major depression. Six of these were responders. Responders reported increased ability and willingness to talk, (especially about painful topics), with relief of tension-anxiety, anger-hostility and depression. Response was not measured separately for each diagnosis.
Emrich HM, Vogt P, Herz A. Possible antidepressive effects of opioids: action of buprenorphine. Ann N Y Acad Sci. 1982;398:108-12.
During the four day buprenorphine treatment phase, patients were give 0.2 mg sublingual tablets twice a day.
About 50% of patients responded “very strongly” to buprenorphine; about 50% were nonresponders.
Emrich HM, Vogt P, Herz A, Kissling W. Antidepressant effects of buprenorphine. Lancet. 1982 Sep 25;2(8300):709.
During the four day buprenorphine treatment phase, patients were give 0.2 mg sublingually two times per day.
Four patients showed more than a 50% reduction in depression when they had been on buprenorphine for 203 days; two patients showed a moderate response and four a slight reduction.