The Anti-Suicidal Potential of Buprenorphine: A Case Report
Open accessAbstract
The very strong relationship between suicide, depressive disorders, and substance use disorders is well recognized. Certain pain syndromes are significantly associated with suicide, irrespective of co-occurring medical or psychiatric diagnosis. Chronic pain, depression, substance use disorders, and suicide appear to involve overlapping neural pathways and brain regions that function in the processing of emotional and physical pain, as well as maintaining reward and anti-reward circuitry. In this article, we employ a clinical case to illustrate how various stressors disrupted the balance between pain and opioid-facilitated analgesia. This disruption resulted in excessive use of short-acting opioids to treat pain with ensuing allostatic overload and culmination in chronic suicidal ideation with a suicide attempt. Sublingual buprenorphine was selected to treat the opioid use disorder. We propose that the unique pharmacodynamics of this drug served to stabilize dysregulated neural circuits, neurotransmitters, and neuropeptides, allowing the mitigation of pain, assuaging opioid cravings, easing depression, and resolving suicidal ideation. To our knowledge, this is the first case report to describe the possible anti-suicidal effect of sublingual buprenorphine.
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A few case reports show similar effects in opioid use disorder patients on higher doses.
“Few case reports demonstrate similar effect in individuals with opioid use disorder using higher dosages (139, 285, 286).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [286]
Six clinical trials, one clinical case, and three additional studies investigating opiate-dependent patients were included, with 216 subjects with treatment-resistant depression treated with buprenorphine in monotherapy or with an opioid antagonist.
“Overall, six clinical trials [41,42,43,44,45,46]—of which three were randomized, double-blind and placebo controlled studies [41,44,45]—and one clinical case [47], including a total of 216 subjects with TRD treated with BUP in mono-therapy or together with an opioid antagonist (naloxone or samidorphan) were included.”
From The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review (2018) · cites this paper as [47]
Buprenorphine has a rapid antidepressant and anti-suicidal action, acting in about a week after the first administration.
“Taken together, according to the included studies, BUP has a rapid antidepressant and anti-suicidal action: in fact, this psychoactive compound seems to act in about a week after the first administration [41,42,43,44,46,47,48,52].”
From The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review (2018) · cites this paper as [47]
Striebel and Kalapatapu described a 61-year-old woman with chronic opiate-dependent back pain and depression treated with buprenorphine/naloxone 16 mg/4 mg daily, which was associated with no craving, managed pain, improved mood, and arrested suicidal ideation.
“Striebel and Kalapatapu [47] described the case of a 61-year old women affected by chronic-opiate dependent back pain and depression who was treated with 16 mg/4 mg of BUP/naloxone daily. This drug combination was associated with no craving, managed her pain, and improved her mood, arresting suicidal ideation.”
From The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review (2018) · cites this paper as [47]
In some studies, the antidepressant action of buprenorphine is prolonged for up to one to three months.
“On the other hand, there are also studies [42,47,48,50,51] suggesting that this action is prolonged in time up to one to three months.”
From The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review (2018) · cites this paper as [47]
In one case-a woman with severe opioid use disorder comorbid with treatment-resistant depression and severe suicidal behavior-buprenorphine was titrated up to 16 mg.
“while in just one case—a woman with severe opioid use disorder in comorbidity with TRD and severe suicidal behavior [47]—BUP was titrated up to 16 mg.”
From The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review (2018) · cites this paper as [47]
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A brain-centric model of suicidal behavior
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- Authors
- Striebel, J. M., & Kalapatapu, R. K.
- Affiliations
- San Francisco VA Medical Center (US)
- Corresponding author
- Striebel, Joan M.
- Venue
- The International Journal of Psychiatry in Medicine
- Publisher
- SAGE Publications
- Published
- 2014-02
- Volume
- 47
- Issue
- 2
- Pages
- 169-174
- ISSN
- 0033-278X (ISSN-L)
- 0091-2174
- 1541-3527
- PMC
- PMC4120471
- OpenAlex
- W2031713694
- Cited by
- 31
- References
- 17
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 7 · 2019: 2 · 2018: 6 · 2017: 2 · 2016: 2 · 2014: 1
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The International Journal of Psychiatry in Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (K23DA034883)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- buprenorphine, suicide, suicidal ideation, opioid use disorder, chronic pain, depression, analgesia, allostatic overload, opioid craving, sublingual buprenorphine
- MeSH terms
- Suicide Prevention, Administration, Sublingual, Allosteric Regulation, Analgesics, Opioid, Brain, Buprenorphine, Drug Interactions, Female, Humans, Middle Aged, Narcotic Antagonists, Opioid-Related Disorders, Suicide, Suicide, Attempted, Comorbidity, Substance Abuse Treatment Centers, Suicidal Ideation, Chronic Pain, Depressive Disorder, Treatment-Resistant
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