Friday, December 18, 2015

Low-Dose Buprenorphine Found to Decrease Suicidal Ideation, but Experts Remain Cautious

Short-term use of very low doses of buprenorphine may help to decrease severe suicidal ideation in some patients, but this finding should be interpreted cautiously, Yoram Yovell, M.D., Ph.D., co-director of the Institute for the Study of Affective Neuroscience at the University of Haifa, Israel, and colleagues wrote in a study published today in AJP in Advance.

A total of 88 patients (aged 18 to 65) who reported clinically significant suicidal ideation (a score of greater than or equal to 11 on the self-report Beck Scale for Suicide Ideation for at least one week) were randomly assigned to receive sublingual buprenorphine lozenges, starting at 0.1 mg once or twice a day (n=57), or placebo (n=31) for four weeks. Once a week, at the decision of the study psychiatrists, the daily dose could be raised in 0.1 to 0.2 mg increments, to a maximal daily dose of 0.8 mg.

At two weeks and four weeks, scores on the Beck Scale for Suicide Ideation dropped significantly for the patients who received the low-dose buprenorphine (mean final dosage=0.44 mg/day) compared with those taking placebo. The effects of buprenorphine on suicidal ideation did not differ between patients who were concomitantly treated with antidepressants and those who were not. Patients with and without borderline personality disorder also had similar responses to buprenorphine.

The researchers noted that despite buprenorphine’s “favorable safety profile, [the medication] is potentially addictive and possibly lethal.” They cautioned, “This is a single, time-limited trial of an experimental treatment for suicidal ideation rather than suicidal behavior, and its results do not support the widespread, long-term, or nonexperimental use of buprenorphine for suicidality.”

In an accompanying editorial, former APA President Alan Schatzberg, M.D., a leading psychopharmacology researcher and professor of psychiatry at Stanford University School of Medicine, also noted the risks of addiction or diversion of buprenorphine. He drew an analogy about “the abuse liability, long-term risks, and social cost” in the use of ketamine to treat depression.

“The potential gain of some patients versus the overall societal cost needs to be addressed, and guidelines need to be promulgated for any such use [of buprenorphine],” wrote Schatzberg. “The time has come for the specialty and regulators to begin to formally address the issues associated with the potential off-label use of drugs of potential abuse for severely ill and refractory patients.”

For related information, see the Psychiatric News article “APA Task Force to Address ‘What’s Next?’ for Ketamine.”

(Image: Alexander Raths/Shutterstock)