Naltrexone Treatment of Combined Alcohol and Opioid Dependence: Deterioration of Co-morbid Major Depression

Naltrexone is frequently used for the treatment of opioid or alcohol dependence. However, the reports on its potential to worsen affective disorders are contradicting. Here we report on a patient with combined alcohol and opioid dependence whose co-morbid major depression deteriorated reversibly and repeatedly under naltrexone. By exchanging buprenorphine for naltrexone, his depression and craving for alcohol and opioids disappeared. This underlines the close interaction between depression, substance dependence and the opioid system.

References

• 1 Bent-Hansen J, Lunde M, Klysner R, Andersen M, Tanghoj P, Solstad K, Bech P. The validity of the depression rating scales in discriminating between citalopram and placebo in depression recurrence in the maintenance therapy of elderly unipolar patients with major depression.  Pharmacospychiatry. 2003;  36 313-316
• 2 Bodkin J A, Zornberg G L, Lukas S E, Cole J O. Buprenorphine treatment of refractory depression.  J Clin Psychopharmacol. 1995;  15 49-57
• 3 Bodnar R J, Hadjimarkou M M. Endogenous opiates and behavior: 2002.  Peptides. 2003;  24 1241-302
• 4 Cowan A. Buprenorphine: new pharmacological aspects.  J Clin Psychiatry. 2003;  133 (Supp) 3-8
• 5 Croop R S, Faulkner E B, Labriola D F. The safety profile of naltrexone in the treatment of alcoholism. Results from a multicenter usage study. The Naltrexone Usage Study Group.  Arch Gen Psychiatry. 1997;  54 1130-1135
• 6 Crowley T J, Wagner J E, Zerbe G, Macdonald M. Naltrexone-induced dysphoria in former opioid addicts.  Am J Psychiatry. 1985;  142 1081-1084
• 7 Farren C K, O’Malley S S. Occurrence and management of depression in the context of naltrexone treatment of alcoholism.  Am J Psychiatry. 1999;  156 1258-1262
• 8 Hollister L E, Johnson K, Boukhabza D, Gillespie H K. Aversive effects of naltrexone in subjects not dependent on opiates.  Drug Alcohol Depend. 1981;  8 37-41
• 9 Kosten T R, Morgan C, Kosten T. Depressive symptoms during buprenorphine treatment of opioid abusers.  J Subst Abuse Treat. 1990;  7 51-54
• 10 Malcolm R, O’Neil P M, Von J M, Dickerson P C. Naltrexone and dysphoria: a double-blind placebo controlled trial.  Biol Psychiatry. 1987;  22 710-716
• 11 Maxwell S, Shindermann M S. Use of naltrexone in the treatment of alcohol use disorders in patients with concomitant major mental illness.  J Addict Dis. 2000;  19 61-69
• 12 Regier D A, Farmer M E, Rae D S, Locke B Z, Keith S J, Judd L L, Goodwin F K. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the epidemiologic catchment area (ECA) study.  JAMA. 1990;  264 2511-2518
• 13 Ritter A J. Naltrexone in the treatment of heroin dependence: relationship with depression and risk of overdose.  Aust N Z J Psychiatry. 2002;  36 224-228
• 14 Salloum I M, Cornelius J R, Thase M E, Daley D C, Kirisci L, Spotts C. Naltrexone utility in depressed alcoholics.  Psychopharmacol Bull. 1998;  34 111-115
• 15 Streeton C, Whelan G. Naltrexone, a relapse prevention maintenance treatment of alcohol dependence: A meta-analysis of randomized controlled trials.  Alcohol Alcohol. 2001;  36 544-552
• 16 Strohle A, Holsboer F. Stress responsive neurohormones in depression and anxiety.  Pharmacopsychiatry. 2003;  36 (Suppl 3) S 207-214