Opioids for Depression and Anxiety: Are They Effective?

Prior to the 1950s, opioids were the prescription drug of choice to treat depression. While they were reasonably effective, people easily developed tolerance to opioids so that they required higher doses just to have the same effect on their mood. Further, opioids are highly addictive, and when it would come time to taper off medication, not only did people go through opioid withdrawal, they found that their depression worsened. A change was needed, new antidepressants began to be developed, and opioids fell out of fashion as a depression treatment.

Now, researchers are beginning to take another look at the potential opioids offer for depression and anxiety treatment. To understand why and to come to your own conclusion about whether opioids are effective for these mental health conditions, it’s helpful to know how the body’s own opioid system works.

Your Brain’s Own Opioid System and What it Has To Do with Depression and Anxiety

Opioids have a very specific way that they work, which is known as the opioids mechanism of action. The opioid system includes four different types of opioid receptors as well as four opioids produced in the brain and body.

Opioids attach to receptors and go to work, doing things like relieving pain and producing a euphoric high. Where do these opioids come from?

Opioids can originate outside of the body (known as exogenous opioids) and include morphine, Vicodin, oxycodone, heroin, and many others (Types of Opioids and Opioids Examples). They can also originate in our own brain and body (known as endogenous) and include hormones and neurotransmitters that we know as endorphins, dymorphins, enkephalins, dynorphins, and endomorphins.

The opioids naturally produced in our brain are required for our wellbeing. Our opioid system is important in controlling feelings of pain, stress, anxiety, hopelessness, and pleasure. Researchers are looking into the theory that if someone has a deficiency somewhere in the opioid system in which not enough endorphins, etc. are produced, opioid medication can fill the gap. The possibility is strong that prescription opioids could help depression and anxiety.

That said, the opioid system and all types of opiates, as well as depression and anxiety, aren’t that simple. It’s not a matter of topping off the opioid tank and calling it good. First, there are the dangers of taking opioids even for legitimate medical reasons (the chances of dependence, addiction, overdose, and opioid deaths are significant). Also, we have different types of opioid receptors which cause different reactions. Some have been shown to improve depression and anxiety while others have shown to worsen depression and anxiety.

Opioids for Depression and Anxiety

It’s becoming increasingly clear to researchers that there is a relationship between opioids and depression. Opioid dysfunction in the brain and body can contribute to

• Inability to feel pleasure, which is a major effect and symptom of depression
• Mood-related difficulties

Different opioids can interact with different receptors, increasing feelings of pleasure, improving energy and mood, and blocking activity in opioid receptors that cause these depression-related problems. Prescription opioid medication would activate some receptors and block others to treat depression. Among the opioids for depression, buprenorphine has shown great potential for use as an antidepressant.

Researchers are still very hesitant as to whether prescription opioids such as buprenorphine should be used in mental health treatment. In addition to developing tolerance and possibly opioid addiction, opioids might disrupt the reward system of the brain as well as decrease motivation—things that are already problematic in depression.

Experts are weighing the pros and cons of using opioids for depression. They’re doing the same for anxiety, and the picture so far is equally unclear. Some things are known about the connection between opioids and anxiety:

• Deficiencies in the opioid system can contribute to anxiety.
• Our opioid receptors and opioids themselves play a role in stress and anxiety.
• Our system boosts the effects of anti-anxiety medications such as the benzodiazepines
• Some components of this opioid system actually increase anxiety
• Anxiety is one of the symptoms of opioid withdrawal, so taking an opioid for anxiety, then stopping, defeats the purpose of taking an opioid medication in the first place

Two things are becoming clear: taking prescription opioids for depression and anxiety can be effective, and taking opioids for these conditions can be dangerous due to the nature of opioids. Research is still ongoing on the endogenous opioid system and how this part of our brain and body contributes to anxiety and depression, and studies continue on how exogenous opioids work on that system to improve mental health. Will the benefits outweigh the risks of opioids for depression and, separately, opioids for anxiety? We’ll have to wait and see.

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