Millions of Americans experience suicidal thoughts, and there are no quick-fixes available.
But a commonly used painkiller could offer some much-needed relief.
In a recent study published in the American Journal of Psychiatry, severely suicidal patients who were given low doses of the drug buprenorphine reported having fewer suicidal thoughts after two weeks and four weeks, compared with a group that was given a placebo.
While this was a preliminary study, the drug could become the first fast-acting anti-suicide drug if future studies can repeat the team’s findings, New Scientist reported.
More than nine million adults in the US reported having suicidal thoughts in 2013, and roughly 1.3 million people attempted it, according to the Centres for Disease Control and Prediction.
Antidepressants and some anti-psychotic medications can be effective, but they often take weeks or longer to kick in. The party drug ketamine may provide quicker relief, but it needs to be administered often, and has side effects like hallucinations.
However, some research has shown that drugs that treat physical pain, known as opioids, may also treat emotional pain. These drugs mimic natural brain chemicals which are released when we experience physical injury or social rejection.
Mental pain relief
Jaak Panksepp, a neuroscientist at Washington State University, and some colleagues in Israel decided to take this a step further, to see if a opioid drug could help treat people with suicidal thoughts. These thoughts are often the result of psychological pain — “the feeling you have when you lose loved ones,” Panksepp told Business Insider.
They gave very low doses of buprenorphine, a drug prescribed to treat heroin addiction, to 40 people thought to be severely suicidal (almost half of whom had attempted suicide). They gave another group of 22 suicidal patients a placebo.
The participants later completed a survey designed to measure suicidal thoughts, known as the Beck Scale for Suicide Ideation. It asks about things like a person’s desire to live or die, plans to commit suicide, and frequency of suicidal thoughts.
After two weeks, patients who received buprenorphine scored lower on the Beck Scale, meaning they were less suicidal, compared with the placebo group. And these improvements persisted when they were tested after another two weeks.
The researchers also noticed a smaller improvement among the placebo group after two weeks, but this went away after a month. In fact, the placebo effect has been well-documented, and research suggests it can be explained by the release of opioids in the brain in response to a doctor’s healing touch.
Patients who were also using antidepressants and suffered from borderline personality disorder experienced the same relief from taking buprenorphine. And those who received the drug did not suffer from withdrawal after they stopped taking it, the researchers said.
Battling the addiction stigma
Using opioids to treat depression is not new. They were widely used to treat depression from the 1850s to 1950s. But they were replaced by modern antidepressants because they were addictive, and overdoses can be fatal.
Opioid addiction has become a major problem in the US. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, according to the CDC. Research suggests that opioid abuse can make people more likely to use heroin because the drugs have similar effects on the brain.
Panksepp and his colleagues chose buprenorphine because it is considered to be less lethal than other opioids in an overdose, and they gave it in the lowest possible dose to avoid making people addicted. Still, they had to conduct the study in Israel because of the resistance they faced from opioid watchdogs in the US, he said.
But there may be another, less scientific, reason for the opposition to using older drugs like buprenorphine for treating depression. “People don’t want to use it in psychiatry because if this is better than the stuff they sell, an off-patent medication is not going to make lots of money,” Panksepp said.
A clinically approved version of buprenorphine (sold in a mixture called suboxone) is already available in the US for treating opioid addiction. Doctors could technically prescribe the drug for depression and suicidal thoughts, but Panksepp thinks they would face opposition from the Food and Drug Administration.
Of course, the drug still needs to go through additional, larger studies before it’s safe to start recommending it for treating suicidal depression. But if the effects are confirmed, doctors should be allowed to prescribe it, Panksepp said.