The Role of Opiates in Social Pain and Suicidal Behavior
With more than 800,000 deaths by suicide each year and 20 to 30 times more suicide attempts worldwide, suicide is a major public health problem. Current treatments of SB are mainly based on pharmacological treatments that are not specific of SB (e.g. anti
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ontents 1 Introduction 2 Physical and Social Pains Are Sharing Common Pathways 2.1 Social Pain and Opioid System 2.2 Social Pain and Suicidal Risk 2.3 Opioid Consumption in Relation to Suicidal Behavior 3 Suicidal Behavior and Opioid System 4 To New Pharmacological Treatments for SB 5 Conclusions References
Abstract With more than 800,000 deaths by suicide each year and 20 to 30 times more suicide attempts worldwide, suicide is a major public health problem. Current treatments of SB are mainly based on pharmacological treatments that are not specific of SB (e.g. antidepressants), and new therapeutic targets are urgently needed. Recent data strengthen the ancient conception pain (social, psychic, physical) that is at the core of the suicidal process and should be incorporated in the clinical assessment of suicide risk. Then, the mechanisms involved in the regulation of pain may open new avenues regarding therapeutic perspectives. Opiates appear to be a promising candidate in treatment of SB. Indeed, since the last two decades, growing evidences suggest an implication of the opioid system in the pathophysiology of SB, this conduct to the elaboration of randomized controlled trials (RCTs) B. Nobile, E. Olié, and P. Courtet (*) Department of Emergency Psychiatry and Acute Care, CHU, Montpellier, France PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France University Montpellier, Montpellier, France e-mail: [email protected] P.-E. Lutz Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France © Springer Nature Switzerland AG 2020 Curr Topics Behav Neurosci https://doi.org/10.1007/7854_2020_167
B. Nobile et al.
using opiates in patients with SB. Results suggesting an anti-suicidal effect of buprenorphine and the potential opioidergic-related anti-suicidal effect of ketamine both contribute to the growing interest in opiates use in SB. In this review, we will summarize a large part of the evidence that leads researchers and clinicians to be interested in the use of opiates for SB treatment and discuss on new opioid pharmacological options for suicidal patients. Keywords Opiates · Opioid system · Pain · Suicidal behavior · Therapeutics
1 Introduction Suicide is a major public health problem. Indeed, there are more than 800,000 deaths by suicide each year and 20–30 times more suicide attempts (SA) worldwide (Zalsman et al. 2016). With the entry in DSM-5 of suicidal behavior (SB) as a disorder proposed for complementary studies, suicide is now regarded as an entity with its own physiopathology. Current treatments of SB are based on psychotherapy (e.g., cognitive behavioral therapy, dialectical behavioral therapy) (Ducasse et al. 2018a; Calati and Courtet 2016) and on pharmacological therapeutics (antidepressants, clozapine, and lithium) (Courtet and Olié 2014). Yet, these pharmacological treatments are not specific of SB, and n
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