[Pharmacotherapy in heroin addiction: pharmacological approaches to remission stabilization and recurrence prevention]

Abstract

After withdrawal arrest in many heroin addicts, they displayed the syndrome of anhedonia including affective disorders (depression, dysphoria, anxiety), dyssomnia and a pathologic craving for opiates. Anhedonia is often the cause for recurrence in heroine addiction, therefore, an appropriate treatment is an important aspect in recurrence prevention and remission stabilization. Since depression and drive for heroin are the key symptoms in anhedonia, we undertook the efficiency study of therapy (in anhedonia) by antidepressants belonging to the selective serotonin reuptake inhibitors (SSRI) and NMDA receptor antagonists, citalopram and memantine, respectively, which have a clinical antidepressant action and an experimental anti-addictive action. Both drugs were found to arrest effectively virtually all signs of anhedonia, however, their action on remission stabilization was rather moderate. It looked to be more promising to use, in remission stabilization, the uttermost antagonist of opiate receptors (naltrexone) blocking reliably all heroine effects. A double blind placebo-controlled study, undertaken by us, convincingly showed a significantly smaller number of relapses with naltrexone in heroin addicts. At the same time, the drug had no valuable effect on the anhedonia symptoms, which worsened the compliance entailing a poorer therapy efficiency. Finally, a combination of naltrexone (blocking the heroin action and reducing the recurrence rate) with SSRI antidepressants (effectively arresting the anhedonia symptoms and improving the compliance with naltrexone medication and remission quality) is a most promising approach to remission stabilization and recurrence prevention.