Posted by Elizabeth on March 12, 2002, at 9:59:28
In reply to Re: sidetrack from Addiction » Elizabeth, posted by Zo on March 9, 2002, at 18:39:03
> I realized I must charge you, as PB's resident Buprenex authority, with remembering my experiences with Bupe and adding them to your encycolopedia.
I'm not really keeping a list of case reports, although perhaps I should try to do that. But yes, I do take into account that a lot of people actually feel worse on opioids, and it's good to have some case reports.
> Remember that it is available as a troche,
Don't you need to get it through a compounding pharmacy to do that? There aren't a lot of those (compounding pharmacies, that is), and compounded nedications tend to be expensive. (And buprenorphine is already pretty expensive.)
> Paradoxically, it was that episode that finally made my Bipolar II dx concrete; my pdoc subracted the bupe, added Lamictal---and I have been steadily undepressed and unsuicidal since then.
I'm not sure that antidepressant-induced mania is proof of bipolar disorder (according to DSM-IV, it's not supposed to be). Of course, if you always get manic on ADs, and you need ADs for depression, then you pretty much have to be on mood stabilizers (I think that's supposed to be considered bipolar NOS, not bipolar II). I got manic (mixed -- very horrible, I know what you're talking about) when I had a severe episode of the central serotonin syndrome, and the weird nasty depression type thing that happened when Nardil pooped out may also have been a mixed state, but these were considered to be isolated cases -- most antidepressants don't make me manic. So I might have a minor *tendency* to manic switching, but nobody would actually say I'm bipolar.
> September, I think it was.
Ahh, September. That was when I had that seizure-whatever-thingie episode. I've been taking Trileptal to prevent stuff like that; I also went off desipramine, which I think was probably a contributor.
> If I were in a place to track and respond to the bupe threads, I'd also have to talk a a bit about letting any one med becoming the holy grail--having lived that process over and over, for long enough, as have others here of course.
Yeah, I don't mean to imply that it's some kind of holy grail. I try to warn people about the side effects, potential withdrawal symptoms, etc. I definitely think it's not for everyone; rather, it's something to consider if you're seriously treatment-resistant or can only achieve partial remission with regular ADs and the more common augmentation strategies. I think opioids should pretty much be a last resort (except for ECT) and should probably usually be reserved for severe depressions.
> I'd add something about Bupe's unavailability helping it appear as Grail--and about my being "saved" after all this time, by something as ordinary as Lamictal. . . at the same time that I'd discourage NO one from going after it. . . I think you understand.
I do understand. But I'd actually discourage most people, probably. The reason is that I usually find that people who say they've tried "everything" have left some things out that are worth trying for them (often things like Lamictal, that are, as you say, pretty ordinary).
> You're in a powerful position here to affect the suffering of others, as I know you know. You've given great hope to many; I hope my experiences can add something to your admirable efforts.
Gosh, thanks. :-} I do know that, and it kind of weighs on me -- like, I feel like I have a major responsibility to be very careful in making suggestions. You know? But I really want people to know that there are things that they can try that their doctors aren't likely to suggest spontaneously, and I'm not just talking about buprenorphine here.
> I'll have to do a post with the whole gory med history. . .
I'd like to get a nice history of what happened when you took bupe, in particular. I'm puzzled by the mixed episode thing: of course I've heard of mania induced by monoaminergic ADs, but never before from an opioid. Then again, I've been sort of wondering whether buprenorphine has some unidentified nonopioid effect (perhaps involving catecholamines). What do you think?
-elizabeth
poster:Elizabeth
thread:93100
URL: http://www.dr-bob.org/babble/20020307/msgs/97606.html