Opiate treatment in ECT-resistant depression

Aims: Until the 1950s opiates were often used in the treatment of depressive disorders (1). Because of the development of the tricyclic antidepressants, opiates fell into oblivion concerning this indication. However, only 2 of 3 depressive patients respond to newer antidepressants today, and even ECT achieves a remission-rate of only about 70%. Method: 3 patients (2f, 1m; 24, 39, 50y), suffering from major depression, were unresponsive to Tricyclics, SSRIs, Tranylcypromine, Venlafaxin and different combinations. Even ECT up to 14 treatment sessions remained unsuccessful. Subsequently, in an open label study patients were given Buprenorphine 0.8–2mg/d or Oxycodon 20mg/d as monotherapy. Results: In course of the opioid medication, within 1 week the HAMD-score decreased from 24.0 (range 19 to 28) before treatment to 4.3 (2 to 8) with opiate treatment, the BDI-score decreased from 27.3 (23 to 35) to 10.3 (9 to 12). Temporary appeared nausea, obstipation and dysphoria. Conclusion: Opiates can be a hopeful option in treatment-resistant depression (TRD), even if ECT fails. Our results confirm former studies (2), but a new aspect is that in some cases of TRD opiates can be more effective than ECT. Perhaps, in these cases the endogenous opioid system is more impaired than the monoaminergic systems (3).