Is buprenorphine an antidepressant?

No, buprenorphine is not an antidepressant. But you might feel less depressed after taking buprenorphine (Suboxone or Subutex). More on buprenorphine and depression here.

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Can Suboxone treat both opiate addiction and depression at the same time?  Dr. Burson says, “No. Buprenorphine is not an antidepressant”.  But should your Suboxone doctor consider using this opioid to treat the disease of depression? Maybe.  Read more about the potential of buprenoprhine as an antidepressant during opiate withdrawal here.

What is the disease of depression?

When doctors talk about the disease of depression, we aren’t speaking of a bad feeling that we all get when having a terrible day. Doctors consult a set of diagnostic criteria that describe a situation of chronically low mood, significant enough to cause considerable suffering. In patients with major depression, we see feelings of low self-worth, hopelessness, and even suicidal thoughts. People with the disease of depression don’t feel pleasure from previously pleasurable activities. We believe this kind of depression is caused by an imbalance of brain chemicals. In the past, scientists thought that the main chemicals affecting mood are serotonin and norepinephrine, and our presently available antidepressants work by adjusting these brain chemicals.

But over the years, it’s gotten more complicated. As science evolves, we’ve begun to see that other brain chemicals affect mood. For example, estrogen and testosterone, the sex hormones, affect mood.  Also, the stress hormones like cortisol play a role in the control of mood, and also may be a factor in the development of addiction.

Can opioids affect mood?

The research on mood and addiction overlap.  Addiction and the brain are interrelated, as are mood disorders and the brain…suggesting future discoveries about how mood disorders and addictions are related. Researchers know that we make our own opioids, called endorphins, which affect mood. At present, we don’t have a way to measure these endorphins, but some scientists believe it’s possible that some people are born with low levels of endorphins. When they use opioids, perhaps they feel “normal.” Without opioids, they may feel chronically low in mood. Perhaps opioids help these unfortunate people to feel like people born with adequate endorphins. This is an exciting area of research, which may help us understand why some people are much more susceptible to addiction than others.

People who have become addicted to opioids experience withdrawal when they don’t have access to their drug of choice. Besides the physical symptoms, which can be quite severe, many addicts also feel depressed and anxious. When they use an opioid, those bad feelings go away, along with the physical symptoms. So opioids elevate a depressed mood, but the depressed mood was caused by addiction to opioids in the first place. This is the official answer to the question of why some people feel less depressed when taking Suboxone. But it’s probably not so simple.  And to find Suboxone doctors taking patients, you’ll need to look at the SAMHSA listing for buprenorphine physicians or check out the Suboxone manufacturer’s website for more information.

Is buprenorphine / Suboxone an antidepressant?

No. Strictly speaking, Suboxone, which is the brand name of the generic drug buprenorphine, is not an antidepressant.

However, Suboxone is an opioid. All opioids, by stimulating opioid receptors, create feelings of expansive well-being, and even euphoria. This is the “high” that some people become addicted to. If someone is in a foul mood, using an opioid usually produces a much better mood. Suboxone, since it’s only a partial opioid, causes less euphoria, but still can cause this good feeling.  Doctors further prescribe buprenorphine sublingual tablets during opiate withdrawal or for opiate addiction maintenance programs, as its effects are relatively mild and supportive of a better lifestyle.


Should we consider treating depression with opioids?

About the author
Jana Burson M.D. is board-certified in Internal medicine, and certified by the American Board of Addiction Medicine. After practicing primary care for many years, she became interested in the treatment of addiction. For the last six years, her practice has focused exclusively on Addiction Medicine. She has written a book about prescription pain pill addiction: "Pain Pill Addiction: Prescription for Hope." Also see Dr. Burson's blog here.
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