Opiates and opioids in particular, are primarily used for treating pain, but there is a long history of using these substances to manage mental illnesses. In the mid-1800s Victorian era, Laudanum (known as tincture of opium today), was used for depression and hysteria, as well as to soothe small children, with 25 drops selling for a single penny. Interestingly also, I’ve had several patients divulge that the only time in their adult lives they were ever able to socialize with ease, make friends, function smoothly at work, and not feel plagued by apathy, hopelessness, self-doubt, a lack of confidence, and anxiety was when they were hooked on opioids. All of these patients had quit the opioid use years earlier, and after doing so, all of these above-mentioned symptom difficulties came back.
We remain mired in an opioid crisis of epidemic proportions in this country, so it’s understandably difficult to recall that many opioids are naturally manufactured by our brains and are responsible for our feelings of well-being. Brain circuitry using these opioids control pain, stress, and displeasure, while also pleasurable feelings and even euphoria.
Obviously, considerable caution should be exercised in light of the number of lives this opioid epidemic has taken, but reputable bodies of well-respected clinical work indicate that certain opioids may actually be beneficial in treating psychiatric conditions such as depression that have been historically difficult to treat via antidepressants. With the exception of Spravato (esketamine), all the contemporary antidepressants are linked to the same three neurotransmitters implicated in depression—norepinephrine, serotonin, and dopamine. But with the paltry success rate of these agents, scientists and clinicians have banded together and are in agreement that other pathways in the brain to better manage mood should be explored. The opioids are thus being considered.
It’s understandable that consternation would arise when it comes to thinking of the opioids as possible alternatives for depressive syndromes given the extent to which they’ve damaged our society in recent years. Yet opioids have a storied history in treating melancholic conditions right up to the release of the first “official” antidepressants in the 1950s. Will such history repeat itself? We don’t know, but for individuals suffering from treatment-resistant depression in particular, we absolutely need medications with higher and more prolonged success rates.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.