Treatment of Obsessive-Compulsive Disorder with oral Morphine

[Changa707]

Greetings fellow blue/green-lighters and lurkers, I just stumbled upon a good article while researching off-label uses of opioids to treat psychological disorders such as OCD.

Article title: Double-Blind Treatment With Oral Morphine in Treatment-Resistant Obsessive-Compulsive Disorder

Link to the original article doesn't work because of permission issues, but this link contains a few excerpts...I have also included a few excerpts from the original article (conclusion).

http://www.currentpsychiatry.com/ho...cations/2f58cf84551917e368f476a892fb713c.html

Opioids. A double-blind, placebo controlled crossover study of 23 patients with treatment-refractory OCD found once-weekly oral morphine added to patients’ current regimen significantly reduced Y-BOCS score vs placebo. Patients received 30 mg the first week and 15 to 45 mg the next week, depending on response or side effects.A case report and a small open-label trial support the efficacy of tramadol, a weak agonist of the μ opioid receptor and an inhibitor of serotonin and norepinephrine transporters, as monotherapy and as an adjunct to fluoxetine. Because patients with OCD may be particularly vulnerable to dependence and intentional or accidental overdose via opioid/benzodiazepine combinations, evaluate the risks and benefits before initiating an opioid.

Conclusion: Our results and those of others 3,4,7,8,13,14 suggest a role for morphine or other mu-receptor agonists in the man- agement of treatment-refractory OCD. The response seen, its rapidity, and the relative tolerability of the treatment are encouraging and warrant larger and longer-term stud- ies. Future trials should also assess the abuse potential of opiates in this patient population. Although we did not witness euphoric effects in any of our subjects, and none reported euphoria, the study’s limited duration might 358 Oral Morphine for Treatment-Resistant OCD J Clin Psychiatry 66:3, March 2005 359 not have been adequate for such complications to become manifest. Drugs with less abuse potential than morphine, such as methadone, a mu-agonist, and buprenorphine, a mixed agonist/antagonist at the mu-receptor, deserve study. The effect of morphine and other mu-receptor agonists on glutamatergic function in brain regions abnor- mally active in OCD, together with recent evidence sug- gesting that glutamate may play a role in the pathophysi- ology of OCD, 21–23 also suggests that the therapeutic potential of glutamate antagonists such as memantine and lamotrigine should be explored.

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I have never been diagnosed with OCD, but have recurring obsessive thought patterns which can be very debilitating at times. In recent years I myself have experimented more and more with opioids and found that they do a great job of taking one's mind of whatever it is that is bugging them (I know this is not a revelation). But the question is, at what point are OCD symptoms bad enough to justify opiate addiction as a substitute?
Well, this article seems to suggest that non-euphoric/minimal weekly dosages of morphine to can alleviate OCD symptoms for extended periods. This seems to be very promising, but I am still wondering if addiction is going to be a major risk for these patients. As the article suggests, Methadone and Buprenorphine need to be looked at...and I would suggest also looking at Pethidine.

Any thoughts/experiences on this would be greatly appreciated!

 

[AlphaMethylPhenyl]

Opiates/oids are good drugs for pain. They aren't prescribed in psychiatric practice because they were abused so much. I think decriminalization of drugs will happen before any drugs from this class get approved for reasons other than opiate/oid dependence. The only drug that really shows some promise in my mind is buprenorphine, and that is strictly controlled.It's my understanding that the benefits of mu agonism wears off quickly as one becomes tolerant to the drug. The delta- subtype is another story, though. It has shown promise in treating depression, etc.

There are much better drugs for OCD, taking into account abuse potential.

Comparatively, I would think that OCD is such a minor illness to say, schziophrenia, that there wouldn't be a lot of research going in to developing new drugs for it. SSRIs work well for OCD in my experience.

Of course the pain goes away when one is on an opiate. Of course you feel like you are fulfilling your dreams. But you're not. They are tricky.

 

[f33lg00d]

I totally think that buprenorphine is the best opioid for this as of now. Because it builds tolerance very slowly, lasts all day, and has less abuse potential. At a small dose like .5mg or less could probably benitfical. It makes sense because a big part of withdrawal is OCD-like symptoms.