Esketamine Effects on Buprenorphine Treatment in a Comorbid Case of Opioid Addiction with Depression, Obsessive-Compulsive Disorder and Chronic Pain - Abstract
Ketamine is a N-methyl-D-aspartate glutamate receptor antagonist that has efficacy against chronic major depression. Its mechanism of action likely depends on changes in glutamate-mediated transmission and plasticity in circuits involved in a wide range of neuropsychiatric disorders and addictions. Although ketamine can reduce opioid requirements in a pain context, no prior reports have documented its impact in the context of treatment of opioid addiction. We describe treatment outcomes with esketamine in a patient with treatment-resistant depression, obsessive-compulsive disorder, chronic pain and opioid addiction treated with the partial opioid agonist buprenorphine/naloxone. During esketamine treatment, the patient spontaneously self-tapered his buprenorphine/naloxone (16/4 mg to 8/2 mg) without experiencing withdrawal or rebound pain, and with some improvement in his obsessive compulsive disorder. Short term modulation of the glutamate system with esketamine or other novel compounds should be more systematically tested for efficacy in patients with complex comorbidities of mental illness and addiction.