Over 21 million Americans have a substance use disorder, yet only 11% of them get the treatment they need. This results from many factors, the biggest of which are stigma and lack of access to care. Those seeking treatment for mental health issues like depression and anxiety often face similar barriers. Sadly, problems with substance use and mental health often go hand-in-hand, and using opioids often worsens depression and anxiety symptoms.
Options like telehealth and medications for addiction treatment (MAT) are steadily improving access for at-risk individuals. However, it’s important to note that all medications come with risks and side effects — especially if you’re taking more than one simultaneously. If you’re being treated for opioid use disorders (OUD) and depression or anxiety simultaneously, it’s crucial to be transparent about your medications with doctors. At Ophelia, your dedicated care team will work with you to create a comprehensive care plan that ensures you receive a safe, effective treatment for OUD and co-occurring mental health conditions.
Going through MAT and mental health treatment
Finally, getting help for OUD and mental health issues can be a massive relief, but knowing what you’re taking and how it will affect you is crucial. Suboxone is a medication approved by the Food and Drug Administration (FDA) to treat OUD (important safety information). It’s highly effective, typically reducing death rates from opioid use by 70-80%. Although Suboxone is the most common medication for MAT, there are dozens of prescription drugs used to treat depression and anxiety, including benzodiazepines (aka benzos) like Xanax® and Valium® and Selective Serotonin Reuptake Inhibitors (SSRIs) like Prozac® and Zoloft®.
Many patients are unaware that their medications don’t interact well or fail to tell their doctors because they don’t seem related. Sometimes the stigma of seeking help for one issue can prevent you from talking about the other. Clinicians and mental health professionals must ensure their patients feel comfortable and safe opening up about their entire medical history.
How does Suboxone interact with antidepressants?
Mixing Suboxone with antidepressants and anti-anxiety medications can sometimes have dangerous results when patients are not monitored. Here’s how the most common prescription medications can interact.
SSRIs
SSRIs are a form of antidepressant that works by increasing serotonin levels in the brain. Taking a dose of Suboxone also results in a boost of serotonin. When taken together at normal doses, this interaction is nothing to worry about. However taking extra doses could lead to a dangerously high level of serotonin — a possibly life-threatening condition known as serotonin syndrome. Symptoms include rapid heart rate, restlessness, confusion, muscle tension, and high blood pressure.
Tricyclic antidepressants (TCAs)
Tricyclic antidepressants (TCAs) were among the first drugs developed to treat depression and anxiety. Common examples include Amitriptyline®, Amoxapine®, and Doxepin®. They are meant to improve serotonin and norepinephrine levels. This neurotransmitter is associated with improved mood and energy. TCAs taken with Suboxone may also lead to worryingly high serotonin levels and sedation in the context of overdose.
SNRIs
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another commonly prescribed class of antidepressants. They include brand names like Pristiq®, Cymbalta®, and Effexor®. SNRIs perform the same function as TCAs, increasing serotonin and norepinephrine levels in the brain. Like SSRIs and TCAs, SNRIs may cause serotonin syndrome in extreme instances. Some SNRIs may not cause sedation however.
Benzodiazepines
Benzodiazepines are depressants with a sedating effect, often used to treat anxiety and insomnia. They work by relaxing your body and mind, making you feel drowsy. Suboxone also might cause drowsiness. The sedative effects of both at once can increase the risk of respiratory depression (slow and shallow breathing), overdose, and death.
A retrospective cohort study in Massachusetts found that patients taking buprenorphine (Suboxone) and benzodiazepines together were three times more likely to suffer a fatal opioid overdose than those who took buprenorphine alone and twice as likely to experience a non-fatal overdose. However, those on prescription benzodiazepines were also associated with a decreased risk of discontinuing MAT.
What antidepressants are safe to take with Suboxone?
While taking Suboxone and antidepressants or anti-anxiety medications together has risks, research shows that concurrent treatment is associated with improved retention. That means that if you receive treatment for depression or anxiety during MAT, you’ll be less likely to relapse. Because of this, clinicians need to determine the proper prescriptions for each patient.
So what’s the best antidepressant with Suboxone treatment? The truth is, there is no single “best” antidepressant to take with MAT. Side effects for all of these drugs will vary by patient, especially when combined with Suboxone. You’ll find the right prescription antidepressant or anti-anxiety meds by talking with your clinician. They’ll consider your health and medication history before determining your treatment, then monitor the drug’s effectiveness and side effects as you take it. When you work together, you can find a safe and healthy way to treat OUD and depression or anxiety simultaneously.
Get the comprehensive care you need with Ophelia
If you’re dealing with mental health issues alongside OUD, you need compassionate, research-based care that treats you as a whole. Ophelia provides comprehensive care, from a personal clinical care team and assistance getting your Suboxone prescription to ongoing medical support and treatment for depression and anxiety. To determine if Ophelia is the right fit for you, answer a few questions and set up a quick 15-minute video call to get started.
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