buprenorphine--naloxone-drug-combination and Bipolar-Disorder

Buprenorphine and naloxone (Suboxone) is a combination medication-assisted treatment (MAT) for opioid use disorder. MAT withdrawal-induced psychosis is a rare clinical presentation. To our best knowledge, only three reports have summarized the characteristic manifestations of buprenorphine withdrawal psychosis, yet all of them were male. In this case report, we present a 41-year-old female patient with bipolar disorder and comorbid substance use disorder who developed new-onset psychosis and relapse of manic symptoms following abrupt discontinuation of Suboxone. Manic and psychotic symptoms remitted after a short-term hospitalization with the treatment of an antipsychotic and a mood stabilizer. In addition to discussing this case presentation and treatment approach, we review existing literature and discuss possible underlying mechanisms to enhance understanding of this clinical phenomenon.

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Female; Humans; Male; Naloxone; Psychotic Disorders; Substance Withdrawal Syndrome

Buprenorphine is commonly used to manage opioid use disorder; however, the literature describes its potential role in treating treatment-resistant depression.. We present a patient with bipolar disorder and opioid use disorder, who presented status post-suicide attempt.. After initiating buprenorphine-naloxone, the patient reported rapid improvement in depressive symptoms, pain, and suicidal ideation.. This case demonstrates buprenorphine's antisuicidal and mood-stabilizing capabilities, potentially via antagonizing κ-opioid receptors as well as reinstating the balance between reward and antireward circuitry.. This case highlights buprenorphine-naloxone as a treatment for both treatment-resistant depression and opioid use disorder, as well as buprenorphine's rapid antidepressant, analgesic, and antisuicidal effects. (Am J Addict 2021;30:80-82).

Topics: Adult; Analgesics, Opioid; Bipolar Disorder; Buprenorphine, Naloxone Drug Combination; Burns; Depression; Humans; Male; Opioid-Related Disorders; Pain; Receptors, Opioid, kappa; Suicidal Ideation; Suicide, Attempted