title: Anhedonia, depression, anxiety, and craving in opiate dependent patients stabilized on oral naltrexone or an extended release naltrexone implant.
abstract: Naltrexone is a μ-opioid receptor antagonist that blocks opioid effects. Craving, depression, anxiety, and anhedonia are common among opioid dependent individuals and concerns have been raised that naltrexone increases them due to blocking endogenous opioids. Here, we present data that address these concerns.
  
  
  
  Assess the relationship between affective responses and naltrexone treatment.
  
  
  
  Opioid dependent patients (N = 306) were enrolled in a three cell (102ss/cell) randomized, double blind, double dummy, placebo-controlled 6-month trial comparing extended release implantable naltrexone with oral naltrexone and placebo (oral and implant). Monthly assessments of affective responses used a Visual Analog Scale for opioid craving, the Beck Depression Inventory, Spielberger Anxiety Test, and the Ferguson and Chapman Anhedonia Scales. Between-group outcomes were analyzed using mixed model analysis of variance (Mixed ANOVA) and repeated measures and the Tukey test for those who remained and treatment and did not relapse, and between the last measure before dropout with the same measure for those remaining in treatment.
  
  
  
  Depression, anxiety, and anhedonia were elevated at baseline but reduced to normal within the first 1-2 months for patients who remained in treatment and did not relapse. Other than a slight increase in two anxiety measures at week two, there were no significant between-group differences prior to treatment dropout.
  
  
  
  These data do not support concerns that naltrexone treatment of opioid dependence increases craving, depression, anxiety or anhedonia.
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.|b Department of Addictions, Bekhterev Research Psychoneurological Institute , St. Petersburg , Russia.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Edwin
authors.initials: E
authors.lastname: Zvartau
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Elena
authors.initials: E
authors.lastname: Verbitskaya
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Valentina
authors.initials: V
authors.lastname: Wahlgren
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Marina
authors.initials: M
authors.lastname: Tsoy-Podosenin
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Bushara
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Andrey
authors.initials: A
authors.lastname: Burakov
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Masalov
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Romanova
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Arina
authors.initials: A
authors.lastname: Tyurina
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Palatkin
authors.affiliation: a Department of Pharmacology , St. Petersburg Pavlov State Medical University , St. Petersburg , Russia.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Yaroslavtseva
authors.affiliation: c Department of Psychiatry, Treatment Research Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Pecoraro
authors.affiliation: c Department of Psychiatry, Treatment Research Institute , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: George
authors.initials: G
authors.lastname: Woody
mesh_terms: D000284:Administration, Oral; D000328:Adult; D059445:Anhedonia / Q000187:drug effects*; D001007:Anxiety / Q000139:chemically induced / Q000150:complications / Q000523:psychology*; D066249:Craving / Q000187:drug effects*; D003692:Delayed-Action Preparations; D003863:Depression / Q000139:chemically induced / Q000150:complications / Q000523:psychology*; D004311:Double-Blind Method; D004343:Drug Implants; D005260:Female; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D004343:Drug Implants; D009271:Naltrexone
keywords: Opioid; anhedonia; clinicaltrials.gov Identifier: NCT00218426; naltrexone