Ultra-Low-Dose Buprenorphine as a Time-Limited Treatment for Severe Suicidal Ideation: A Randomized Controlled Trial
| Autor: | Irina Briskman, Gali Bar, Amihai Rigbi, Amit Lotan, Yoram Yovell, Jaak Panksepp, Moti Mashiah, Jack Asherov, Yehuda Baruch |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Narcotic Antagonists Administration Sublingual Poison control Placebo Suicidal Ideation law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Double-Blind Method Randomized controlled trial law Internal medicine medicine Humans Psychiatry Suicidal ideation Endogenous opioid Psychotropic Drugs business.industry Mental Disorders medicine.disease Buprenorphine 030227 psychiatry Substance abuse Psychiatry and Mental health Treatment Outcome Adjunctive treatment Drug Therapy Combination Female medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | American Journal of Psychiatry. 173:491-498 |
| ISSN: | 1535-7228 0002-953X |
| DOI: | 10.1176/appi.ajp.2015.15040535 |
| Popis: | Suicidal ideation and behavior currently have no quick-acting pharmacological treatments that are suitable for independent outpatient use. Suicidality is linked to mental pain, which is modulated by the separation distress system through endogenous opioids. The authors tested the efficacy and safety of very low dosages of sublingual buprenorphine as a time-limited treatment for severe suicidal ideation.This was a multisite randomized double-blind placebo-controlled trial of ultra-low-dose sublingual buprenorphine as an adjunctive treatment. Severely suicidal patients without substance abuse were randomly assigned to receive either buprenorphine or placebo (in a 2:1 ratio), in addition to their ongoing individual treatments. The primary outcome measure was change in suicidal ideation, as assessed by the Beck Suicide Ideation Scale at the end of each of 4 weeks of treatment.Patients who received ultra-low-dose buprenorphine (initial dosage, 0.1 mg once or twice daily; mean final dosage=0.44 mg/day; N=40) had a greater reduction in Beck Suicide Ideation Scale scores than patients who received placebo (N=22), both after 2 weeks (mean difference -4.3, 95% CI=-8.5, -0.2) and after 4 weeks (mean difference=-7.1, 95% CI=-12.0, -2.3). Concurrent use of antidepressants and a diagnosis of borderline personality disorder did not affect the response to buprenorphine. No withdrawal symptoms were reported after treatment discontinuation at the end of the trial.The time-limited, short-term use of very low dosages of sublingual buprenorphine was associated with decreased suicidal ideation in severely suicidal patients without substance abuse. Further research is needed to establish the efficacy, safety, dosing, and appropriate patient populations for this experimental treatment. |
| Databáze: | OpenAIRE |
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