Organic mood syndrome associated with detoxification from methadone maintenance

Objective: The authors delineate the clinical characteristics ofmood state changes that occur in stable opioid-dependent patients undergoing therapeutic detoxification from methadone maintenance treatment. Method: Twenty-four patients participated in a blinded protocol for gradual methadone dose reduction that included weekly assessments of affective state using the Profile of Mood States (POMS) as well as weekly assessments of signs and symptoms of opioid withdrawal. Data obtained before methadone dose reduction and during the 2-week period ofmaximal dysphoric symptoms were compared. Changes in affective and opioid withdrawal measures were compared in patients who differed in their success in completing the detoxification regimen. Results: Sustained increases in POMS scores ofgreater than 20 points were observed in 12 ofthe 24 patients during the course ofdetoxification. The emergence of symptoms of dysphoria was accompanied by insomnia, loss of appetite, and somatic complaints consistent with symptoms of opioid withdrawal but only minimal levels of objective signs of withdrawal. Greater changes from baseline in mood state and opioid withdrawal measures occurred in patients who were unable to complete the detoxification regimen. � clusions: The development ofan organic mood syndrome is a common occurrence in patients undergoing slow detoxification from methadone maintenance treatment and is associated with a poor outcome. (Am J Psychiatry 1993; 150:423-428)