Are Opioids the Next Antidepressant?

http://www.nytimes.com/2016/06/05/opinion/sunday/are-opioids-the-next-antidepressant.html

Essentially, all the anti-depressants now in use affect a single group of neurotransmitters called monoamines and are likely to treat only specific subtypes of depression. Clinicians and scientists alike are in agreement that other pathways in the brain that control mood need to be explored. The opioids are one such pathway…

Opioids may also hold out hope for a devastating illness formally known as borderline personality disorder. Characterized by severe emotional dysregulation, patients with this disorder have feelings of loneliness, rejection, anger and sadness that can quickly overwhelm them. They struggle to maintain relationships and are terrified of abandonment. They are often substance abusers and — in fact — opioids are frequently their drugs of choice. In one study, 44 percent of patients seeking buprenorphine treatment for their opioid addiction were found to have borderline personality disorder. There are no Food and Drug Administration-approved medications for this illness…

Research looking at opioid receptors in patients with borderline personality disorder in comparison to control subjects has documented abnormalities in these patients’ opioids system. It is a finding that would help explain why many opioid abusers describe the sensation they get from using drugs not as “getting high” but as “getting right,” or as “feeling normal.”

It may seem counterintuitive and even dangerous to be considering the medicinal use of substances that are currently a scourge to our society. Yet opioids have a long history of being used to treat melancholia and other psychological disorders — right up until the 1950s, when the current group of antidepressants were discovered…