A Double-Blind Study of Buprenorphine Treatment of Acute Suicidality
Status:
Unknown status
Trial end date:
2008-11-01
Target enrollment:
Participant gender:
Summary
The acutely suicidal patient presents a complex and dangerous clinical dilemma. Many suicidal
patients receive antidepressant medications, but the onset of action of these medications is
at least three weeks, and despite their established antidepressant effect, they have not
shown a clear anti-suicidal benefit. Psychoanalysts hypothesized that depression (often
leading to suicidality) shares important characteristics with the psychological sequellae of
object loss and separation distress. Endogenous opioids (endorphines) have been implicated in
mediating social bonding and separation distress in mammals. Anecdotal evidence and several
clinical studies found the mixed opioid agonist-antagonist buprenorphine to be an effective
antidepressant with a rapid onset of action. It is therefore hypothesized that buprenorphine
may be a novel and quick-acting treatment for acute suicidality, especially in the context of
depression. The proposed double-blind study will examine the effect of buprenorphine on
acutely suicidal inpatients. Depression, suicidality, and overall functioning will be
assessed before, during and after a two-week buprenorphine/placebo trial. A small subgroup of
patients will also be treated with short-term psychoanalytic psychotherapy throughout the
study period. It is hypothesized that subjects who receive the active drug will show rapid
improvements in objective and subjective measures of suicidality and depression.