Suboxone (Buprenorphine) is a medication that is used by people withdrawing from narcotics (opioids). It helps alleviate withdrawal symptoms and most people end up able to experience a smooth withdrawal while on this particular drug. In people that have either extreme or treatment-resistant depression, many have turned to trying a variety of drugs besides that of SSRI’s, TCA’s, and MAOI’s. Some individuals have discovered through personal trials and research that the drug Suboxone can have profound antidepressant effects.
However, it is considered a Schedule III substance in the United States and is not approved by the FDA for the treatment of depression. In order to get your hands on this substance for the treatment of depression, you’d either need of have a comorbid opiate addiction or you’d need to have a very liberal psychiatrist and prove that absolutely nothing else works. In most cases, people explore other, more proven and studied treatment options for depression as Suboxone is a highly unorthodox option.
Suboxone (Buprenorphine) for Depression: Research
Recently, researchers have began to take a look at whether this medication could be used to treat depression. In the mid 1990’s, Harvard Medical School conducted a clinical trial and demonstrated that in individuals with non-psychotic, major depression that was unresponsive to a traditional antidepressant or electroconvulsive therapy, Suboxone successfully treated their symptoms.
Although the use of narcotics is not approved for the treatment of depression, some doctors are starting to realize that they do have antidepressant effects in their patients. In cases where patients are non-responsive to traditional antidepressant treatments, they need other options. Some would argue that it’s better to feel happy and be addicted to a medication like Suboxone than it is to be depressed, unproductive, and highly suicidal.
Research has shown that both mental and physical pain are regulated with the same chemical networks in the brain. Many people who are depressed also report feelings of pain. Newer medications like Cymbalta – attempt to address both physical pain and mental pain associated with depression.
Suboxone acts as a partial agonist against the mu-opioid receptor which releases both serotonin and dopamine in the central nervous system. It should be noted that these neurotransmitters are released to a lesser degree than full agonists. Some would hypothesize that the antidepressant properties of Suboxone can be derived from the release of dopamine and serotonin.
Taking Suboxone for Treatment-Resistant Depression
Obviously if you are taking Suboxone to treat depression, you either have a comorbid opiate addiction or you have a very liberal psychiatrist. At one point when I was feeling really depressed, I talked to my psychiatrist about testing this medication. He actually is a licensed Suboxone doctor and he advised that I explore other options. At the end of the day I’m glad I didn’t end up on this stuff because my depression did improve with other treatment.
This medication is not approved as an antidepressant and is considered to be a pretty potent drug. My psychiatrist did acknowledge that maybe one day this would be a valid treatment option – but it needs to first be approved. With that said, most people who end up taking Suboxone for their depression end up having positive experiences. I would classify this as an unauthorized, last-resort type treatment if absolutely nothing else works to pull you out of your black hole.
Why consider Suboxone for treatment-resistant depression:
- No other relief – If you can’t find any other relief via other drug classes (SSRI’s, TCA’s, MAOI’s), have explored electroconvulsive therapy, tried adjunctive treatments such as (Lithium and Adderall) talk therapy, etc. and nothing works.
- Highly suicidal – Feeling highly suicidal is a huge problem.
- Coexisting opiate addiction – In individuals that are having a difficult time coming off of heavy opiates, this may be ideal to help treat both the addiction and depression.
- It works quickly – Most people that try this medication report that it works very fast.
Benefits of Suboxone for Depression
1. Improved mood: Many people report an immediate improvement in mood upon taking Buprenorphine. It works as a partial agonist on the mu-receptor and increases serotonin and dopamine – both of which are linked to mood improvement.
2. Increased pleasure: It is common for activities to become more pleasurable as a result of taking this medication. Since the pleasure chemicals are increasing in your nervous system, it makes sense that you’d have an increased sense of pleasure.
3. Feeling normal: Some people take this medication and report that they feel “normal” for the first time in years. If you have significantly low levels of serotonin or dopamine, this can help boost them.
4. Decreases anxiety: In some people, they report decreases in anxiety and increases in relaxation. This is in part due to the fact that it acts on the mu-receptor in the brain and increases both serotonin and dopamine.
5. Increased wellbeing: Some people report overall improvement in wellbeing. They are able to be productive members of society, wake up in the morning, be social, and positively interact with the world.
Why you may want to avoid Suboxone for depression
Even if you are gung-ho about trying Suboxone to treat your depression, and end up with a prescription, there are some things you may want to think about. As with any drug, or medication, it is important to know how it will affect you, how powerful it is, and the long term effects. If you ever want to come off of the medication, the withdrawal process must be properly understood.
- Strength: Some people may want to stay away from this medication because it may make them feel “too good.” Many people that use this medication for depression have reported feeling a sense of euphoria. If you are feeling “too good” it may be a sign that the dosage is too high.
- Feel “high”: Although not everyone reports feeling “high” on a drug, this is a medication that could give a non-opiate user a “high.” Despite the fact that this may be pleasurable, it may not be what you need in order to function normally in society.
- Dependency: Due to the production of serotonin and dopamine and this drug’s effect on the mu-receptor, people can easily become dependent. There are many cases of people that have become so psychologically and physically dependent that they plan on using it for life. Source: http://www.ncbi.nlm.nih.gov/pubmed/11408600
- Long term effects: What are the long term effects of Suboxone? We really don’t know. This is a major problem because if there are detrimental side effects, it may affect your decision to use this medication in the first place.
- Side effects: As with any drug, not all side effects are going to be feelings of pleasure and joy. Some people may not respond well to this medication and may actually end up more depressed. Even though this seems to be pretty effective at treating depression, some people end up with bad experiences.
- Withdrawal: The withdrawal associated with this medication is extremely difficult. It typically requires a gradual “weaning” process depending on the dosage. Some people claim that the withdrawal is so difficult that they plan on staying on Suboxone forever.
Suboxone for depression verdict: More research needs to be conducted
I suggest that further studies be conducted in patients with opiate addiction and comorbid severe depression to determine the effectiveness of Suboxone. Additionally, further research needs to be conducted regarding the long term effects of Suboxone. If this medication really works well in cases of severe and/or treatment-resistant depression, it may be very beneficial to use.
We aren’t sure about the long term effectiveness of this medication either. Does it eventually stop working or “poop out” like most antidepressants? Do we have to keep increasing the dosage over time? These are some questions that need to be addressed. With that said, I’d say that the rate of SSRI dependency is pretty high for people.
Most people that end up on SSRI’s stay on them for as long as they work – which could end up being for a lifetime. Researchers should further explore Suboxone. There were some clinical trials with Suboxone for treating depression in the works. If you have used Suboxone to help treat your depression or noticed that it helped you, feel free to share your experience in the comments section below. Also be aware of the new formulation of ALKS-5461 for depression, which is very similar to Suboxone.