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Low dose of buprenorphine reduces suicidal ideation

Short-term use of low doses of buprenorphine was associated with decreased suicidal ideation in severely suicidal individuals without substance abuse, according to results from a multisite, randomized, double-blind, placebo-controlled trial.

“Standard antidepressants relieve suicidal ideation, but this may take several weeks, and not all patients respond adequately. Atypical antipsychotics and lithium have been found to decrease suicidal ideation and/or suicidal behavior in specific patient populations. Ketamine is effective as a quick-acting treatment for suicidal ideation and depression, but necessitates repeated administration under medical supervision. Thus, no short-term pharmacological treatments that are suitable for independent outpatient use are currently available for suicidal ideation,” Yoram Yovell, MD, PhD, of the University of Haifa, Israel, and colleagues wrote.

To determine efficacy and safety of low dosages of sublingual buprenorphine for severe suicidal ideation, researchers randomly assigned severely suicidal patients without substance abuse 2:1 to ultra–low-dose buprenorphine (n = 40) or placebo (n = 22) for 4 weeks. Patients in the buprenorphine group started with 0.1 mg or 0.2 mg daily, and could increase the dose weekly by 0.1 mg to 0.2 mg to a maximum dose of 0.8 mg daily. Study treatment was administered in addition to ongoing individual treatments. Change in suicidal ideation was assessed via Beck Suicide Ideation Scale.

Participants who received buprenorphine had greater reductions in Beck scores than those who received placebo after 2 weeks (mean difference = –4.3; 95% CI, –8.5 to –0.2) and 4 weeks (mean difference = –7.1; 95% CI, –12 to –2.3) of treatment.

Buprenorphine response was not affected by concurrent use of antidepressants or diagnosis of borderline personality disorder.

Withdrawal symptoms were not reported after treatment discontinuation, according to researchers.

“The article by Yovell and colleagues in this issue points to the potential use of low doses of a buprenorphine, a muopioid partial agonist, to decrease suicidal ideation in psychiatric patients,” Alan F. Schatzberg, MD, of Stanford University School of Medicine, California, wrote in an accompanying editorial. “There is a need for replication of these findings with study in both borderline personality disorder and major depression. However, as we have witnessed with ketamine infusion centers sprouting up, the drug will be prescribed by some practitioners and will likely be used by more over time. The field needs to study the use of the drug not only acutely but over the long term to assess efficacy and safety before it is widely adopted.” – by Amanda Oldt

Disclosure: Yovell reports no relevant financial disclosures. Schatzberg reports serving as a consultant for Alkermes, Cervel, Clintara, Forum Pharmaceuticals, McKinsey and Company, Myriad Genetics, Neuronetics, Naurex, One Carbon, Pfizer, Takeda, Sunovion, and X-Hale and as a speaker for Merck and Pfizer; holding equity in Corcept (co-founder), Intersect ENT, Merck, Neurocrine, Seattle Genetics, Titan, and X-Hale; and is listed as an inventor on pharmacogenetic and mifepristone patents from Stanford University. Please see the full study for a list of all authors’ relevant financial disclosures.