From the FDA Drug Label
DOSAGE AND ADMINISTRATION
CLINICAL PHARMACOLOGY
Mechanism of Action Buprenorphine is a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor.
The FDA drug label does not answer the question.
From the Research
Buprenorphine administered intramuscularly (IM) is not recommended for mental health conditions, as its primary use is for opioid use disorder and pain management, and it carries risks including respiratory depression, dependence, and withdrawal. While there is some emerging research exploring buprenorphine's potential antidepressant effects, this remains investigational and is not an approved indication 1, 2. The IM formulation specifically (such as Brixadi/Buvidal) is only approved for opioid use disorder treatment. For mental health conditions, established first-line treatments include SSRIs, SNRIs, atypical antipsychotics, mood stabilizers, and psychotherapy, depending on the specific diagnosis. These treatments have substantial evidence supporting their efficacy and safety profiles for psychiatric indications.
Some studies suggest that buprenorphine may have a role in treating co-occurring psychiatric disorders in patients with opioid use disorder, as receiving antidepressants during buprenorphine treatment is associated with improved retention 3. However, this does not support the use of buprenorphine as a primary treatment for mental health conditions. Instead, it highlights the importance of addressing co-occurring psychiatric disorders in patients with opioid use disorder.
In patients with comorbid opioid use disorder and mental health conditions, buprenorphine may be appropriate for the addiction component, while conventional psychiatric medications address the mental health aspects. It is essential to consider the potential risks and benefits of buprenorphine treatment in these patients, as well as the need for comprehensive care that addresses both the opioid use disorder and the mental health condition.
Key points to consider:
- Buprenorphine is not approved for the treatment of mental health conditions
- Established first-line treatments for mental health conditions have substantial evidence supporting their efficacy and safety profiles
- Buprenorphine may have a role in treating co-occurring psychiatric disorders in patients with opioid use disorder, but this is not a primary indication
- Comprehensive care that addresses both the opioid use disorder and the mental health condition is essential in patients with comorbidities.