Marcia Zuckerman, MDDirector of psychiatric services at Walden Behavioral Care in Waltham, MADr. Zuckerman has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
These days, opiates are primarily prescribed to treat pain. But there is a long history of using opiates to treat depression and other mental illness. Starting in the 700s, Arabian cultures used opium in mental hospitals in Baghdad, Damascus, Fez, and Cairo that also incorporated milieu therapy such as music, reading, and sexual stimulation. In the Victorian era, Thomas Sydenham popularized Sydenham’s Laudanum, a mixture of opium, sherry, wine, and herbs. Laudanum, which was affordable at 20 or 25 drops for a penny, was used for depression and hysteria, as well as to soothe small children. (The laudanum that is currently available by prescription in the U.S., often known as “tincture of opium,” no longer contains alcohol.) Many of the opium preparations were prescribed for women in response to problems with menstruation and childbirth, as well as “the vapours,” a loose term that included hysteria, depression, mood swings, and fainting. As physicians began to appreciate the risk of addiction with opium preparations, they fell out of favor in the medical establishment, leading to regulation and, essentially, prohibition, in 1914 by the Harrison Narcotics Tax Act. Interestingly, the use of opiates to treat depression may have come full circle. Small research studies (eg, Bodkin JA et al, J Clin Psychopharmacol 1995;15(1):49–57) have shown a benefit for Suboxone, an opiate partial agonist-antagonist in treatment resistant depression, although the risk of addiction and misuse may outweigh the benefits.