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Vivitrol和抑郁：病例報(bào)告及文獻(xiàn)復(fù)習(xí)
The introduction of a long-acting depot formulation of naltrexone (Vivitrol), FDA approved for the treatment of alcohol and opioid dependence in 2006 and 2010, respectively, has raised safety concerns including: (1) risk of development or exacerbation of depressive symptoms during treatment; and (2) increased risk of opioid overdose after treatment cessation. The concern that treatment with long-acting naltrexone may lead to depressive symptoms has a plausible theoretical basis given the medication’s blockade of μ-opioid receptors, which, when activated, lead to positive mood states. Risk of depression and suicidality are listed as potential adverse reactions in the manufacturer’s insert and are commonly relayed to patients during informed consent for treatment (http://www.vivitrol.com/About/Safety). However, these concerns may not be substantiated. Given that depression is commonly comorbid with alcohol and opioid dependence, concerns about the exacerbation of depression could prevent many individuals from receiving beneficial treatment as more evidence emerges supporting the efficacy of depot naltrexone. A recent multisite randomized trial found that opioid-dependent subjects receiving long-acting naltrexone were far more likely to remain abstinent over 6 months of treatment (median of 90% abstinent weeks for naltrexone group vs. 35% for placebo group). In this paper, we review the existing literature on the effects of short-acting and long-acting naltrexone on mood as well as effects on preexisting depressive disorders, with the aim of assisting clinicians in selecting appropriate patients for treatment with this medication.
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- 附件 1 : 00132576-201409000-00007.pdf
2014-09-30 15:38:12, 99.98 K
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