BUPRENORPHINE TREATMENT OF REFRACTORY DEPRESSION

Opiates were used to treat major depression until the mid-1950s. The a dvent of opioids with mixed agonist-antagonist or partial agonist acti vity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unrespons ive to or intolerant of conventional antidepressant agents. Ten subjec ts with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open -label study. Three subjects were unable to tolerate more than two dos es because of side effects including malaise, nausea, and dysphoria. T he remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objectiv e measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four s ubjects achieved complete remission of symptoms by the end of the tria l (Hamilton Rating Scale for Depression scores less than or equal to 6 ), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depre ssion.