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.