Investigating the Effects of Buprenorphine Treatment on Depression Symptoms Among Adults with Opioid Use Disorder: A Scoping Review

OBJECTIVE: More than one-third of adults with opioid use disorder (OUD) have co-occurring major depressive disorder. Yet existing antidepressant pharmacotherapies have shown limited efficacy in this population. Emerging evidence suggests that buprenorphine treatment may reduce depression symptoms among those without OUD, but there is a need to better understand the impacts of buprenorphine on depression symptoms in those with OUD. We conducted a scoping review of the literature exploring the effect of buprenorphine treatment on depression symptoms among adults with OUD. METHODS: Online databases (e.g., PubMed) were used to identify papers published through September 2024 following PRISMA-ScR guidelines. We included 48 full-text articles from 36 unique studies that included a depression outcome at ≥ 2 time points in adults receiving buprenorphine for OUD treatment. RESULTS: Mean depression scores at baseline (largely before initiation) were generally above clinical cutoffs and reduced with buprenorphine treatment. In most cases, depression symptoms rapidly decreased upon buprenorphine initiation. Yet a subgroup of patients (20-37%) receiving buprenorphine appears to experience persistent depression symptoms. CONCLUSIONS: Most individuals with OUD treated with buprenorphine experienced rapid decreases in depression symptoms upon treatment initiation. However, most studies included in the review were not designed to assess the effect of buprenorphine on depression symptoms. Challenges to synthesizing and interpreting study results included small sample sizes, suboptimal measures of depression symptoms and assessment schedules, and widespread exclusion of higher severity subgroups (e.g., individuals with suicidal ideation) in included studies. Future work is needed to explore the mechanisms underlying the antidepressant effects of buprenorphine in people with OUD and to investigate optimal antidepressant treatments for patients who experience persistent depression during buprenorphine treatment.