Depression resistant to antidepressant medications or depression complicated by hypophoria? A case report

Background. The clinical condition of depression resistant to antidepressant drug treatment (TRD) has been described since the early Seventies. In the case of Dual Disorder (Heroin Use Disorder/Depressive) patients, the tendency of psychiatrists to treat subjects with depression by using predominantly psychiatric drugs instead of agonist opioid therapy still persists. The aim of this case study presentation is to support this assessment. Case Presentation. A 45-year-old male with a history of opiate addiction, use and resistance to treatment was monitored for many years, while continuing to be treated with an antidepressant, while a correct methadone or buprenorphine treatment was avoided; the outcome was that no significant clinical improvement occurred until a very complex treatment system was applied. Comment. This patient was misdiagnosed as resistant to treatment. None of the doctors responsible for his health considered the possibility that the severity of his symptoms and the low level of his response to therapy might be due to a hypophoric/dysphoric syndrome induced by previous long-term opiate abuse and not responding to standard agonist opioid treatment. In such cases, good clinical practice suggests that agonist opioid therapy with over-standard dosages may be indicated in depressed patients with opioid addiction.