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Suboxone (Buprenorphine) For Treatment-Resistant Depression: Partial Mu-Opioid Agonist

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.

Source: http://www.ncbi.nlm.nih.gov/pubmed/7714228

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.

Source: http://clinicaltrials.gov/ct2/show/NCT01407575

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{ 85 comments… add one }
  • Laurence December 10, 2017, 1:45 pm

    I have Major Depressive Disorder and GAD. Started at age 17. I’m now 56. Finally sought help 24 years ago then went thru the same routine as many others commenting here: every kind of antidepressant, electro convulsive, ketamine, talk therapy, acupuncture, hypnosis. Nothing helped.

    In March this year I tried Suboxone and it worked. Like a miracle. But only for ten days. Then I slipped back into the black hole and that’s where I am now. So discouraging. Trying to ignore the suicidal thoughts and keep searching. Praying for a miracle.

    • Lawrence June 8, 2018, 10:43 pm

      Remarkable how similar our stories are. I’m 56 also and have MDD and severe anxiety. Was maintained for years on Anafranil (I realize it’s prescribed for OCD but it works very effectively for MDD as well. Side effects were awful but I was willing to tolerate them.

      Tried 30 or so of the other AD’s, to no avail. Dr. would wean me off of Anafranil and back on after lack of response to the AD’s.) At any rate, the anafranil stopped working 4 years ago and I have been fighting suicidal depression for the better part of those 4 years. My psychiatrist is progressive and realizes that suicidal depression is nothing to fool with so he recommended Suboxone, after ECT, Ketamine and an MAOI.

      For 2 weeks the suicidal depression vanished. It was transformative. It then reappeared and I am back in the same black hole. Every day is exhausting and taxing. I know I can’t live like this forever – the pain and suffering are simply too much. Hope we both find something that works. Peace – Lawrence

  • Donna J April 12, 2017, 7:17 pm

    I cannot believe I found this site with so many people suffering as I am. Just the fact of so many people reporting what I just read here, should be substantial enough to have suboxone approved for TRD. NO-ONE, unless they themselves have experienced TRD, know what we truly experience and how we suffer.

  • Alicia March 10, 2017, 3:46 am

    I first started my Suboxone treatment for treatment-resistant depression almost four years ago. Like just about everyone else here, I also had run out of treatment options after running through the gambit of antidepressant medications and associated treatment plans, as well as alternative treatments like neurofeedback treatments and amino acid therapy, which only left me broke and STILL depressed.

    I was first diagnosed with depression in 1996 after the birth of my first child. I had been prescribed various antidepressants over the years (I am now 52) — staying on one medication until it would “poop out”, and then my doctor would try me on another medication, and so it went until finally everything just seemed to stop working and I was diagnosed with treatment resistant depression.

    It wasn’t until my ongoing lower back problems that had plagued me for years, flared up once again and I was put on an opiate for the pain. I was on the opiate for a couple of weeks when I started to realize that my depression seemed to magically disappear while I was medicated. That is when I began my own research to try to find out the connection between the opiate medication and depression, and is how I came upon online forums like this which enlightened me to the use of Suboxone for depression.

    I’d never heard of Suboxone before, but I knew it was something I had to at least try. I knew I’d have to find a psychiatrist who not only treated opiate addiction with Suboxone, but I also wanted one very experienced with treating depression, in hopes that they would be able to see the connection themselves and would possibly be willing to think outside the box.

    It took a couple of hits and misses before I found one, but it was well worth the time and effort. I did ask to raise my dosage from one 2mg/0.5mg sublingual strip daily, to one and a half strips daily, but I have been on this relatively low dose for almost the entire four years. Like the others here, I also feel like Suboxone saved my life and I cannot imagine where I’d be today without it.

    I’m sure that I will remain on this medication for the rest of my life, which does concern me with the lack of knowledge we have about the effects of it’s long-term use, but considering the alternative, I’m just so thankful that I am now on it and feeling more stable than I have in a long time. I would love nothing more than to be off of all medications and to be depression free, but for some of us, that is just not possible and I thank God that I found something that works this well and that I have found a doctor who is able and willing to provide me with a prescription each month.

    I am convinced that I would not be here today without it.

  • Tony February 1, 2017, 9:35 pm

    I have suffered from depression since about 18 yrs old. I am now 49. I self medicated with drugs and alcohol for years. About 6 yrs ago my girlfriend was prescribed Norspan which is buprenorphine in a transdermal patch. She gave me one which I applied to my skin, and forgot about until the next morning when I woke up feeling like a new born baby.

    I didn’t feel high but what I would describe as normal or what other people experience as normal. I am now on Subutex which I obtained through a drug program which I got on because I was on Codeine. I made sure there was a high dose of Codeine in my system, as it is an opiate, when I went to the drug clinic and was thus prescribed Subutex.

    Now I feel quite calm balanced and happy on a daily basis. I will never forget that first time I tried it. It was truly like a miracle. It was like “Wow, this is how normal people feel”. Now I can tie my shoelaces with ease and don’t lay around in bed all day waiting for the next drink or drug to give me relief.

    I agree that if you’re going to be on SSRIs for the rest of your life, why not buprenorphine?

  • Beverly January 21, 2017, 4:10 pm

    I share a story very similar to many of you. I’ve suffered from depression for 10 years, at first the meds worked but for the past 3+ years they have not helped much, if any. I’ve never been addicted to any medication, but I drink daily, so I suppose alcohol is my form of self-medication.

    My predominate symptom is anhedonia. I’ve managed to keep my job, marriage in tact, fully functional in all respects apart from not living my life in any meaningful way, i.e., I can’t feel happiness or any pleasing emotion and that makes even getting out of bed a struggle each day.

    I have a wonderful psychiatrist who has tried every med under the sun and is now willing to let me try Suboxone. He is currently taking the required training and I assume I’ll start the medication soon. I am extremely nervous/anxious/worried that it will not work, which will leave me at what feels like “the point of no return”.

    As I understand it, I should feel something very quickly (at the first dose, or at least by the 2nd day), but I would also imagine that if the dose is not high enough (I’m sure he will begin very low) it might take a week or more? So, any words of wisdom regarding “expectations” are much appreciated. I don’t want to freak out if I don’t feel “great” in the first hour, day, or week!?

  • Nancy December 4, 2016, 1:14 am

    I am astonished, and so very hopeful after reading all the positive testimonials here. I am 54 and have suffered from MDD, GAD, panic disorder agoraphobia for 20+ years. I am homebound for nearly 10 years. I have isolated myself from friends and family. Although I certainly didn’t know it at the time, I suffered from anxiety and dysthymia as a child and teen.

    I knew that I was not like the rest of my friends and peers, which in itself was very painful. I was once told as a young adult by my brother’s psychiatrist that I was one of the most painfully shy persons that she had ever met. I was about 16 when Quaalude use and addiction was becoming an epidemic. When I tried my very first one, I finally felt what I thought normal should feel like.

    Gone was my daily persistent anxiety and social awkwardness. I used whenever I had the opportunity. I didn’t know that I most likely suffered from low endorphin production or something similar. Later in life, after suffering from the above mentioned diagnoses, I had a major surgery and was given Morphine in the hospital and a prescription for Percocet.

    Through the years, I had been prescribed nearly almost all of the tricyclics on the market, the SSRIs, the SNRIs and other medications by this time with little to no relief. The side effects and adverse effects were unbearable at times. I came to realize that I have TRD, although no doctor spoke those words. I seriously considered ECT. My daily life consisted of, and still does, moving from bed to couch several times per day.

    I have become indifferent to life. Suicide is not an option, although I will say that I’ve played out several scenarios in my mind. I’ve even wished for an incurable disease to take my life, one for which I would seek no treatment. This is embarrassing and painful to admit. Life is supposed to be cherished, a precious gift. To the point, the Percocet prescribed after surgery drastically changed how I felt on a daily basis.

    I have a family member who sympathized with me and kept me supplied for 4+ years until recently. The Percocet quit working way before I finally decided to detox. I was sick and tired of being dependent on something that was no longer working for me, and withdrawing on my own scared me. I was proud of myself for detoxing, but immediately went back to those dark times x 10.

    I did consider Suboxone prior to detoxing, but why substitute one drug for another just as addictive? Had I found this forum earlier, I would have opted for the Suboxone, no doubt. One way or another, I will go this route in the near future. I do hope that the FDA continues with the trials and does the right thing and acts in the best interest of us mentally ill human beings who deserve quality of life.

    Can you imagine how many lives that will be saved from suicides? Thank you all for sharing such intimate and private information. I wish the best for each and everyone of you.

  • Kyle November 12, 2016, 12:59 pm

    I’ve been on the subs for about a week and in my opinion it is saving my life… MY LIFE! I really can’t believe how much it is helping me with my addiction and depression. Obviously my doctor and I will see what the future holds, but as of now, good God it feels good to be alive again. Not high mind you, I just feel well. I’m optimistic about my future and that hasn’t been something I’ve felt in 15 years or more.

  • sharon larson October 16, 2016, 4:59 am

    God bless each of you. Suboxone didn’t help my depression, so I appear in the minority… and once again I have to live with the fact that AGAIN, IT DIDN’T WORK FOR ME. But I am very happy that it gave nearly all of you the miracle that many of us have been praying for decade after decade. Maybe the unforgiveness in my heart is what is causing me not to receive God’s miracle.

    • Kyle November 12, 2016, 2:08 pm

      Sharon, it’ll happen, maybe not when we want it too? But just keep searching. I wanted this 15 years ago, only now are things coming together. Don’t lose HOPE, please hold on to it and when you’re not expecting things, that’s when it’ll change.

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