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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite the increasing use of other illicit drugs, opioid abuse, overdose, and the ensuing medical complications continue to pose management challenges for the emergency physician. Heroin use is increasing as abusers of cocaine seek a drug to prolong cocaine's effects while blunting the postcocaine depression. Clandestine chemists have created newer, more powerful compounds--designer drugs--whose potencies are many-fold that of the presently available opioids. Aggressive airway support and use of naloxone enable the emergency physician to salvage many of these patients, leaving the many medical complications of parenteral and inhalational use as the greatest management challenge.
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PMID:Opioids and designer drugs. 220 17

Extensive clinical experience has been obtained in the use of opiates during the last decade in special units devoted to symptom control in advanced cancer. Important contradictions have emerged with the clinical pharmacological literature on opiates calling into question its relevance to the treatment of chronic pain. Specifically in the case of morphine it is clear that: it is a very effective analgesic given orally, dosage must be individualized, parenteral use or exotic analgesic 'cocktails' are usually unnecessary, and tolerance, dependence and respiratory depression are rarely common or serious problems which prevent effective pain control provided morphine is used appropriately in accordance with its pharmacological characteristics. Heroin is a suitable alternative to morphine (particularly for intramuscular administration) if differences in milligram potency are taken into account, but has no advantages in terms of either analgesic efficacy or side effects. This paper summarizes clinical experience in the use of oral morphine for cancer pain at St. Christopher's Hospice, any data from clinical investigations which support this approach, and comments on the areas of controversy which have emerged.
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PMID:Oral morphine in chronic cancer pain. 620 Aug 18

Heroin addicts have an exceedingly high rate of suicide. Recent studies with other clinical populations have found that hopelessness is a mediating variable between depression and suicidal behaviors. The present study attempted to discover if this same relationship held with heroin addicts. To test this relationship, 191 addicts were administered the Beck Depression Inventory, the Hopelessness Scale, and the Suicide Contemplation Scale. Suicide intent was found to be significantly correlated with hopelessness, but not with depression. The implications of these findings are discussed.
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PMID:Depression, hopelessness, and suicidal intent among heroin addicts. 727 95

Heroin addicts on 0 or 2 mg of methadone and finishing a 14-day detoxification program, and control subjects were shown a videotape of heroin-related stimuli. Psychological questionnaires were completed before and after the videotape, while physiological responses were monitored during viewing. It was found that the experimental subjects had an increased level of anxiety, depression, and subjective level of craving following the stimulus presentation, with the controls showing no similar change in these measures. In addition, the experimental group had significant increases in heart rate and galvanic skin response compared with controls. The results present some of the first objective evidence of conditioned abstinence occurring in addicts exposed to stimuli closely related to those found in the natural environment.
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PMID:Conditioned responses to a videotape showing heroin-related stimuli. 740 46

Heroin lung is the most frequent complication of heroin intoxication. In September 1991 and January 1993, two young men aged 19 and 22 years presented with a sudden loss of consciousness and cyanosis after injecting heroin. They were both brought to our emergency department in the night and were immediately intubated and given 100% oxygen. Following intravenous naloxone, they both regained consciousness. The first patient's chest X ray revealed increased bilateral perihilar lung markings and mild patchy alveolar edema while the second patient showed a bat's wing shaped confluent alveolar edema. The blood gases in both cases revealed hypoxemia and hypercapnia. Follow-up chest roentgenograms on the second hospital day in case 1 and the third hospital day in case 2 revealed partial clearing of the lung fields. Fever developed on the second hospital day and they both received two weeks of antibiotics prior to discharge. Case 1 had normal pulmonary function testing, but case 2 developed mild restrictive lung changes. Review of the literature shows that heroin can cause a fulminant but rapidly reversible form of pulmonary edema. The treatment for this noncardiogenic pulmonary edema is adequate ventilation, good pulmonary toilet, and naloxone to reverse the respiratory and central nervous system depression. Diuretics, digitalis and morphine are not recommended in the treatment of heroin lung.
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PMID:Heroin lung: report of two cases. 791 90

The function of the central serotonergic system was examined indirectly through the measurement of prolactin (PRL) and cortisol responses to fenfluramine challenges in 27 heroin addicts 2 months after detoxification and in nine healthy volunteers. Heroin abusers included nine addicts with comorbid depressive disorders (Group A), nine with aggressive behavior and antisocial personality (Group B), and nine with heroin addiction uncomplicated by other Axis I and II psychiatric disorders (Group C). PRL and cortisol responses of patients in Group A were blunted, while those of patients in Groups B and C did not differ from those of the healthy volunteers. Cortisol responses in Group A differed significantly from those in the other patient groups and in the normal comparison group for AUC analyses, but the diagnosis x time interaction showed a significant difference only between Group A and the normal group. Our data suggest that the function of the serotonergic system is impaired in heroin addicts with comorbid depression but not in heroin addicts who are not clinically depressed. Thus, the serotonergic system does not appear to be impaired by prolonged opioid exposure, per se.
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PMID:Serotonin function in detoxified heroin abusers: prolactin and cortisol responses to fenfluramine challenge. 857 Jul 67

A sample of 226 drug-dependent individuals consecutively admitted to treatment in the major therapeutic programmes in Greece were assessed at intake with the EuropASI and SCL-90-R. At 4 to 6 weeks, 173 who were continuing treatment were reassessed with the SCL-90-R and interviewed with the SCID-R and the CIDI. Mean age of the subjects was 28 years, and 82.3% were male. Heroin was the main substance of abuse for the large majority (89.8%). Prevalence of AXIS II personality disorders (PD) was 59.5% and the majority (61.2%) had more than one PD. Cluster B was diagnosed in almost half of the subjects (48.6%), Antisocial Personality Disorder (APD) being the most prevalent (33.5%) type of PD. Subjects with APD had an earlier age of initiation of illicit drug use than those without. Subjects with a PD had twice the odds of having a comorbid AXIS I diagnosis and three times the odds of having a mood disorder than those without a PD. SCL-90-R assessments showed that psychiatric symptoms were significantly reduced in the period between intake and the fourth week in treatment. Somatization, Depression and Anxiety symptoms were however less reduced in subjects with a PD than in those without PD. Dropping out from treatment was more strongly predicted by AXIS I than AXIS II disorders, with an increased probability of dropping out in the presence of current mood disorders, whereas current anxiety disorder predicted treatment retention.
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PMID:Personality disorders in drug abusers: prevalence and their association with AXIS I disorders as predictors of treatment retention. 980 20

The short-term effects of intravenous opioids (heroin 20-300 mg, methadone 30-180 mg) on cortical hemoglobin oxygenation were examined by near infrared spectroscopy in ten opioid-dependent subjects and were compared with the effects of saline in ten age-matched normal controls. Heroin and methadone produced a rapid and dramatic decrease in cortical hemoglobin oxygenation. Saline had no effects. Opioid-induced acute deoxygenation of cortical hemoglobin is most likely associated with respiratory depression. Thorough medical monitoring is strongly recommended in intravenous opioid maintenance treatments.
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PMID:Rapid cortical hemoglobin deoxygenation after heroin and methadone injection in humans: a preliminary report. 1061 10

We evaluated 3-month outcomes for reinforcement-based intensive outpatient treatment (RBT), a new relapse prevention behavior therapy for inner city opiate abusers. The therapy provides abstinence-contingent partial support of housing, food and recreational activities, abstinence-contingent access to social skills and job finding group therapy and non-contingent individual counseling, all in the context of a day treatment program. Heroin abusers (n = 52), contacted at a 3-day detoxification unit, were randomly assigned to RBT (n = 28) or referred to community treatment resources (n = 24) after a staff escort from the detoxification unit. For RBT patients, treatment began on the day of discharge; 61% received partial rent support in a recovery house based on the need for drug-free housing; the remainder were eligible for partial support of utility payments where they lived. Abstinence-based contingencies were in effect for 1 month with three times per week counseling available for an additional 2 months. One month after detoxification, 61% of RBT versus 17% of referral patients were enrolled in outpatient treatment (P < 0.01); RBT patients were significantly less likely than controls to have returned to any drug use; and 50% of RBT versus 21% of controls reported 30 days of abstinence from heroin and cocaine with confirmatory negative urine (P < 0.05). RBT patients had significantly lower scores on the Beck Depression Inventory at 1 month (M = 9.0 versus 17.6 for controls; P < 0.05) and showed evidence of less alcohol use and higher rates of employment. These results establish the short-term efficacy for RBT and support continued development and evaluation of this new outpatient behavioral treatment.
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PMID:Reinforcement-based intensive outpatient treatment for inner city opiate abusers: a short-term evaluation. 1066 72

There has been increasing recognition of the problem of fatal opioid overdose. This review examines the pharmacological basis of respiratory depression following opioid administration. Respiration is controlled principally through medullary respiratory centres with peripheral input from chemoreceptors and other sources. Opioids produce inhibition at the chemoreceptors via mu opioid receptors and in the medulla via mu and delta receptors. While there are a number of neurotransmitters mediating the control of respiration, glutamate and GABA are the major excitatory and inhibitory neurotransmitters, respectively. This explains the potential for interaction of opioids with benzodiazepines and alcohol: both benzodiazepines and alcohol facilitate the inhibitory effect of GABA at the GABAA receptor, while alcohol also decreases the excitatory effect of glutamate at NMDA receptors. Heroin and methadone are the major opioids implicated in fatal overdose. Heroin has three metabolites with opioid activity. Variation in the formation of these metabolites due to genetic factors and the use of other drugs could explain differential sensitivity to overdose. Metabolites of methadone contribute little to its action. However, variation in rate of metabolism due to genetic factors and other drugs used can modify methadone concentration and hence overdose risk. The degree of tolerance also determines risk. Tolerance to respiratory depression is less than complete, and may be slower than tolerance to euphoric and other effects. One consequence of this may be a relatively high risk of overdose among experienced opioid users. While agonist administration modifies receptor function, changes (usually in the opposite direction) also result from use of antagonists. The potential for supersensitivity to opioids following a period of administration of antagonists such as naltrexone warrants further investigation. While our understanding of the pharmacological basis of opioid-related respiratory depression has advanced, better understanding of the role of heroin metabolites, the metabolism of methadone, drug interactions and tolerance would all be of considerable value in knowing how best to respond to this problem.
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PMID:Mechanisms of fatal opioid overdose. 1070 31


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