Posted by europerep on January 19, 2012, at 7:22:57
In reply to Re: Buprenorphine for Treatment Resistant Depression, posted by emmanuel98 on January 18, 2012, at 19:02:59
Hey there... I guess you were referring to me as the member who wrote about McLean hospital? I don't know whether they have any studies going on over there, but some of the people who were responsible for the publications on this subject are still working there.
It's true, as Scott said in another thread, that the body of evidence for buprenorphine in TRD isn't fairly huge. It's worth noting though that the little evidence that exists is overwhelmingly positive. It's not a "one study says yes and the other one says no" type of situation. There is also more evidence for the benefits of kappa antagonism in depression treatment (publications by Carlezon et al., also from Harvard).
Lastly, successful treatment of TRD with buprenorphine doesn't obey the same rules as recreational use of opiates in order to "have fun". There are people who have been on the same low dose of buprenorphine for years and are still doing well. Of course, the tricky thing is to find out whether a patient who benefits from buprenorphine is experiencing an antidepressant effect or a mild opiate high. I am probably one of those whose improvement during the first days of taking buprenorphine was more due to a high than due to an antidepressant effect. However, while I can only speak for myself here, tapering off of buprenorphine slowly (!) was not all that problematic for me. And, more than a year later, I still have some of it lying around, and I have no temptation whatsoever to take it. Buprenorphine really isn't a good drug to get high.
In short: for some patients I think it's worth trying, and the people at McLean have extensive experience with it. They know how to go about that type of treatment. They are the people I would try to talk to first when considering using buprenorphine for TRD.
ER
poster:europerep
thread:1007664
URL: http://www.dr-bob.org/babble/20120108/msgs/1007753.html