The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: a randomized, double-blind, clinical trial
The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: a randomized, double-blind, clinical trial
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DOI：
10.1186/s13063-018-2843-9
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发表时间：
2018-08-29
期刊：
影响因子：
2.5
通讯作者：
Ehsaei, Zahra
中科院分区：
文献类型：
--
作者：
Ahmadi, Jamshid;Jahromi, Mina Sefidfard;Ehsaei, Zahra
背景：丁丙诺啡通常用于治疗阿片类药物使用障碍和疼痛综合征。这项研究首次提出了不同的单次高剂量丁丙诺啡（一种部分阿片激动剂（μ阿片受体）、一种强效阿片拮抗剂（κ受体）和一种伤害感受受体部分激动剂）在减少患有阿片依赖共病的急性抑郁症患者的自杀意念方面的有效性的研究。此前的小型研究表明，超低剂量丁丙诺啡可能有助于减少自杀意念。本研究的目的是通过进行随机临床试验，描述不同剂量的丁丙诺啡在 3 天的时间间隔内对自杀性阿片类药物依赖患者的结果。方法：将 51 名符合精神障碍诊断和统计手册第五版 (DSM-5) 阿片类药物依赖和重度抑郁症标准的自杀男性住院患者随机分为三组（每组 17 人），接受单次舌下含服丁丙诺啡（32 mg、64 mg 或 96 mg）。 51 名参与者中，有 47 名患者； 16 名（34.04%）接受 32 mg，17 名（36.17%）接受 64 mg，14 名（29.78%）接受 96 mg 舌下含服丁丙诺啡。他们使用贝克自杀意念量表 (BSSI) 的心理测量评估和基于 DSM-5 标准的访谈进行评估。不包括安慰剂组，因为如果没有积极的药物治疗，严重戒断的可能性很高。该研究是在采取适当预防措施并监测呼吸和心血管措施的情况下进行的。该药物是在患者处于中度阿片戒断状态时给药的，表现为四到五种戒断症状的存在。进行了结构化临床访谈，并进行了尿液毒理学测试。结果：患者完成了为期 3 天的试验课程。结果表明，三组中每组的 BSSI 评分均显着降低（p < 0.01），但各组之间的结果没有差异（p = 0.408）。结论：结果表明单次高剂量丁丙诺啡可以快速治疗自杀意念。单次高剂量丁丙诺啡可能是快速治疗自杀性阿片类药物依赖患者的主要机制药物。需要进行安慰剂对照试验来衡量这种药物的安全性以及生理和心理影响。
Background: Buprenorphine is usually administered to treat opioid use disorder and pain syndromes. This research presents the first study regarding the effectiveness of different singly administered high doses of buprenorphine (a partial opioid agonist (of mu-opioid receptors), a potent opioid antagonist (of kappa-receptors) and a partial agonist of nociception receptors) in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence. It follows small studies that suggest that ultra-low-dose buprenorphine may be useful in reducing suicidal ideation. The goal of this study was to describe the outcome of different doses of buprenorphine on suicidal opioid-dependent patients over a 3-day interval, by conducting a randomized clinical trial.Methods: Fifty-one suicidal male inpatients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for both opioid dependence and major depressive disorder were randomized to three groups (n = 17 per group) to receive a single, sublingual dose of buprenorphine (32 mg, 64 mg, or 96 mg). Out of 51 participants, there were 47 patients; 16 (34.04%) received 32 mg, 17 (36.17%) received 64 mg, and 14 (29.78%) received 96 mg of sublingual buprenorphine. They were evaluated by using psychometric assessment of the Beck Scale for Suicidal Ideation (BSSI) and interviews based on DSM-5 criteria. A placebo group was not included because of the high probability of severe withdrawal without active pharmacological treatment. The study was conducted with appropriate precautions and monitoring of respiratory and cardiovascular measures. The medication was administered while the patients were in moderate opiate withdrawal, as indicated by the presence of four to five withdrawal symptoms. A structured clinical interview was conducted, and urine toxicology testing was performed.Results: Patients completed the 3-day trial course. The outcomes illustrated a significant reduction in BSSI scores within each of the three groups, p < 0.01., but no difference in results between the groups, p = 0.408.Conclusions: The results suggest that a single high dose of buprenorphine could rapidly treat suicidal ideations. A single high dose of buprenorphine may be a main-mechanism medication that gives a rapid treatment for suicidal opioid-dependent patients. Placebo-controlled trials are required to measure the safety and the physiological and psychological effects of this medication.