Tiny doses of opioid could be first fast anti-suicide drug
Could a painkiller turn people away from suicide? A preliminary trial of an opioid called buprenorphine shows that the drug can reduce suicidal thoughts after just one week. If validated in larger studies, it could become the first fast-acting anti-suicide drug.
Such a drug is sorely needed. The US Centers for Disease Control and Prevention (CDC) estimates that more than 9 million adults in the country reported having suicidal thoughts in 2013. Over a million went on to attempt suicide. “Around 400,000 suicidal people are coming to emergency rooms every year,” says Elizabeth Ballard at the National Institute of Mental Health. “Pharmacologically, nothing has been approved for acute treatment of suicidal ideation so anything that can help them is greatly needed.”
When people seek help, they may be offered behavioural therapy or drugs such as antidepressants. But neither of these is guaranteed to alleviate feelings, and both can take six weeks or more to kick in. Ketamine, a drug being considered as an immediate treatment, can cause hallucinations and its effects wear off quickly. “Having something you could use on your own outside of a hospital would be beneficial,” says Ballard.
Jaak Panksepp at Washington State University and his colleagues decided to see whether an opioid can counter suicidal feelings. Opioids are one of the brain’s natural feel-good chemicals. They are released to relieve pain when we hurt ourselves, and are involved when we deal with mental pain, such as that caused by social rejection, a common trigger for suicidal thoughts. Recent studies have shown that the system seems to malfunction in people with depression. Separate work has shown that giving people low doses of opioids decreases their perception of social rejection. “Converging lines of evidence point to a connection between mental pain, depression, suicidal ideation and the body’s natural opioids,” says Panksepp.
Panksepp’s team and collaborators at the University of Haifa in Israel gave very low doses of buprenorphine to 40 people identified as being severely suicidal – almost two-thirds of the group had already attempted to kill themselves. A second group received a placebo. The severity of the participants’ thoughts was measured every week for a month by a psychiatrist using a questionnaire. Half the participants were given their drug to take at home, the other half received it in the hospitals where they were staying for treatment.
At the start of the month-long trial, the average score of the participants was about 20. People given buprenorphine dropped an average of six points after one week and nearly 10 points by the end. Participants given a placebo only dropped two points after the full month of treatment. To put this in context, a score of 20 is deemed worrying enough to hospitalise a person for their own safety. This wouldn’t be thought necessary for a score of 10.
Twelve members of the study were unable to continue beyond the first week because they were so ill and two people – one from each group – attempted to end their lives during the trial. However, a week after the trial finished, everyone who had completed it reported no worsening of their condition.
“Anything with effects even at the two week to month level would help a lot of people,” says Ballard. “I think it’s an exciting area of study.”
Panksepp says he’s confident that giving people higher doses of buprenorphine would have seen the effect kick in even earlier. Upping the dose is likely to be controversial, however, especially in the US, where the abuse of prescription opioids is so bad it is being called an epidemic. The latest information, from 2013, shows that across the country, 44 people died from overdoses of drugs such as OxyContin (oxycodone) each day.
The danger with opioids is that taking too much can dampen a person’s breathing to lethal levels. Of all the opioids, buprenorphine carries the lowest risk because there’s a dose beyond which users get no additional pain-relief – or high. It is even prescribed to people who are addicted to other opioids. What’s more, the daily dosages Panksepp’s team administered were 30 times lower than the amount needed to create an addiction to the drug. No participants reported going through withdrawal once they stopped taking buprenorphine, suggesting that none became dependent on the drug during the study.
“I think they’re onto something. However, buprenorphine acts on a number of different opioid receptors and it’s still unclear which one or ones are playing a role in the anti-suicidal effects,” says Joan Striebel, a psychiatrist with the California Department of State Hospitals. “I hope this work spurs more interest in what specific molecules could be involved in suicidal thought.”
“As a psychiatrist I have spent the last 25 years of my life speaking to people who want to kill themselves on an almost daily basis. Studying and treating the neurochemistry may help us prevent broken lives,” says co-author Yoram Yovell of the Institute for the Study of Affective Neuroscience at the University of Haifa.
Journal reference: The American Journal of Psychiatry, DOI: 10.1176/appi.ajp.2015.15040535
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By Mallory Locklear
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