Buprenorphine trialled for depression in people with dementia

The potential role of transdermal buprenorphine as a treatment for depression in nursing home residents with dementia has been investigated in Norway (Drugs Aging 2018;35:545–58; Clin Interv Aging 2018:13:935–46). The rationale for treatment was that many people living in a nursing home have chronic pain, and chronic pain is associated with depression. Buprenorphine, a partial opioid agonist, may be an option for older people.

However, a 13-week trial involving 162 people living in 46 homes who were randomised to receive placebo or treatment with transdermal buprenorphine or paracetamol found that the opioid had no effect on mood while placebo appeared to reduce depression severity. Furthermore, buprenorphine did not reduce pain, though paracetamol did.

Closer study of the 44 people treated with buprenorphine showed that half discontinued treatment due to adverse events (vs 13% with placebo), mostly due to psychiatric and neurological adverse events. Simultaneous treatment with an antidepressant increased the risk of stopping buprenorphine 23-fold. The opioid also reduced daytime activity by 13% during the first week.

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