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Opioids Don't Treat Depression, Yet People Turn to Them Anyway

sigmond

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by Derek Beres

Much of modern medicine does not consider emotions as a root cause of physical pain. It’s as if humans can divide bodies into psychology and neurology, handled by those respective disciplines, and turn to gastrointestinal specialists, cardiologists, and orthopaedic surgeons for fleshly concerns. While sometimes warranted this persistent division of mind and body is unfortunate.

While the cause of pain is not always apparent it’s also easy to misidentify the problem. Sometimes multiple issues converge in your body, each influencing the others. Instead of implementing a holistic yet scientifically credible approach to healing we remain caught in a hamster wheel of specialization. General physicians purposely overbook to maximize profits while minimizing time with each patient, sending them off to doctors who only treat one specific problem or, worse, whipping out a prescription pad before a proper diagnosis is rendered.

And now, with the promise of smart phone apps removing yet another layer of actual communication with doctors, self-prescription is becoming more prevalent. Since we’re not always adept at diagnosing our problems—“you’re your own best doctor” plays more like an excuse than medicine—and since we’re accustomed to a five minute chat before driving to the pharmacy, it turns out many people are treating emotional pain with opioids. As Olga Khazan reports at the Atlantic,

People with depression show abnormalities in the body’s release of its own, endogenous, opioid chemicals. Depression tends to exacerbate pain—it makes chronic pain last longer and hurts the recovery process after surgery.

Relief offered by a temporary decrease in physical pain might lead to chronic problems, such as addiction and deeper depression, as some opioids have antidepressant properties, Khazan writes. On top of the initial problem a whole slew of tragic reactions begin to occur.

This comes during a time when pharmaceutical companies are being sued for misleading advertising. In Ohio, for example, 20 percent of the state’s population was prescribed opioids in 2016; in 2012, 793 million doses were prescribed. The state’s population that year was 11.55 million. Trigger happy is an understatement.

This led the state’s attorney general, Mike DeWine, to file a lawsuit against a number of companies, including Johnson & Johnson and Purdue Pharma, accusing that they “trivialize the risks of opioids while overstating the benefits of using them for chronic pain.” He’s not alone: lawsuits in California and New York make similar claims.

During a time when 23 million Americans may well be kicked off of insurance in the coming months this is not welcome news. The opioid crisis is the result of a perfect storm: increasing anxiety and stress in modern Americans, translating into physical symptoms; doctors maximizing prescription quotas thanks to ties with pharmaceutical companies; pharmaceutical companies extensively advertising products; shorter doctor visits, resulting in an industry in which writing a script is easier than navigating the tricky world of psychology, personalities, and somatic disorders; patients using multiple doctors to keep bottles filled; a thriving black market and an increase in synthetics imported and cooked up in questionable home laboratories.

continued: bigthink
 
There is nothing in the article to support the statement that "opioids don't treat depression."
 
And the fact is, they're highly effective at eliminating depression (at least mild to moderate depression). Just as long as they don't run out or the user isn't stigmatized for using them that is. Hence they don't work very well for very well in the present context.
 
I think it's a given that opiates don't treat depression just like recreational drugs don't treat depression but people who are depressed will still self medicate with whatever they find available that gives them a positive physical feeling.
 
There is nothing in the article to support the statement that "opioids don't treat depression."

Yeah, the article even contains this quote "some opioids have antidepressant properties" I have been on just about all of the generally prescribed antidepressants and none of them were as effective as oxycodone. I was going to look for a study that tested opioids vs antidepressants, if someone can find one please post it. I was hopeful ALKS-5461 would get approved. last time i checked something went wrong in the most recent trial. I suppose its a rather futile discussion to get into considering the current crackdown on opioids though.

short pubmed article on Buprenorphine for depression: https://www.ncbi.nlm.nih.gov/pubmed/7714228
 
Opioids have been used as antidepressants in the past, and there is no arguing that they are great in that regard. What stopped their use in the field is the oh-so-irrational feel that the patient may, for once, feel too good! I mean, we can't let that happen, right? Better to use shit like SSRIs or SNRIs that may or may not work, and if they do, it takes months for their effects to manifest.

I've been suffering from depression for a while and tried SNRIs; I would use opioids over them anyday. Like someone else here said, the main problem with opioids is running out of them. Which would never be a problem if the general population stopped trying to stop some random people that they don't know from feeling good off substances other than alcohol, nicotine, and caffeine. It's pathetic IMO.
 
this post about tianeptine popped up on my fb page ..

The Behavioral Effects of the Antidepressant Tianeptine Require the Mu-Opioid Receptor.

Depression is a debilitating chronic illness that affects around 350 million people worldwide. Current treatments, such as selective serotonin reuptake inhibitors, are not ideal because only a fraction of patients achieve remission. Tianeptine is an effective antidepressant with a previously unknown mechanism of action. We recently reported that tianeptine is a full agonist at the mu opioid receptor (MOR). Here we demonstrate that the acute and chronic antidepressant-like behavioral effects of tianeptine in mice require MOR. Interestingly, while tianeptine also produces many opiate-like behavioral effects such as analgesia and reward, it does not lead to tolerance or withdrawal. Furthermore, the primary metabolite of tianeptine (MC5), which has a longer half-life, mimics the behavioral effects of tianeptine in a MOR-dependent fashion. These results point to the possibility that MOR and its downstream signaling cascades may be novel targets for antidepressant drug development.

New targets for rapid antidepressant action.

Current therapeutic options for major depressive disorder (MDD) and bipolar disorder (BD) are associated with a lag of onset that can prolong distress and impairment for patients, and their antidepressant efficacy is often limited. All currently approved antidepressant medications for MDD act primarily through monoaminergic mechanisms. Glutamate is the major excitatory neurotransmitter in the central nervous system, and glutamate and its cognate receptors are implicated in the pathophysiology of MDD, and in the development of novel therapeutics for this disorder. The rapid and robust antidepressant effects of the N-methyl-d-aspartate (NMDA) antagonist ketamine were first observed in 2000. Since then, other NMDA receptor antagonists have been studied in MDD. Most have demonstrated relatively modest antidepressant effects compared to ketamine, but some have shown more favorable characteristics. This article reviews the clinical evidence supporting the use of novel glutamate receptor modulators with direct affinity for cognate receptors: (1) non-competitive NMDA receptor antagonists (ketamine, memantine, dextromethorphan, AZD6765); (2) subunit (GluN2B)-specific NMDA receptor antagonists (CP-101,606/traxoprodil, MK-0657); (3) NMDA receptor glycine-site partial agonists (GLYX-13); and (4) metabotropic glutamate receptor (mGluR) modulators (AZD2066, RO4917523/basimglurant). We also briefly discuss several other theoretical glutamate receptor targets with preclinical antidepressant-like efficacy that have yet to be studied clinically; these include α-amino-3-hydroxyl-5-methyl-4-isoxazoleproprionic acid (AMPA) agonists and mGluR2/3 negative allosteric modulators. The review also discusses other promising, non-glutamatergic targets for potential rapid antidepressant effects, including the cholinergic system (scopolamine), the opioid system (ALKS-5461), corticotropin releasing factor (CRF) receptor antagonists (CP-316,311), and others.

https://www.ncbi.nlm.nih.gov/pubmed/28303899
https://www.ncbi.nlm.nih.gov/pubmed/26724279
 
Interesting. I wonder what Tianeptine would be like as a treatment for PAWS?
 
That would be interesting! You'd have to treat lightly if you had an opioid use disorder you were bouncing back from, but used wisely it could be super helpful for people with particularly bad PAWS.
 
I think it's a given that opiates don't treat depression just like recreational drugs don't treat depression but people who are depressed will still self medicate with whatever they find available that gives them a positive physical feeling.

I agree with you. I think there is confusion when people confuse the word "treat" with the word "alleviate". I'm sure opiates can temporarily relieve depression as well as a number of other uncomfortable emotional states; but to confuse that with treatment that can actually get to the roots of depression and offer realistic management or an actual cure is a dangerous ignorance to say the least.
 
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