![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 62. Go back in thread:
Posted by dougb on March 29, 2001, at 12:39:10
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by PhoenixGirl on March 28, 2001, at 16:53:32
Thanks for your reply
> The only possible problem I can see would be > if you had to keep raising the dose to keep
> the same effectiveness, and ended up
> addicted.I have, of course, no interest in further screwing up my miserable little existence by getting addicted.
When pdoc said the same thing i reminded him that my body is now somehow addicted to Zoloft, that i started with 50mg am now up to 300, when i have tried to go off of it (while i still have 2 neurons to rub togother), i got _real_ sick.
So the state is now paying for $400 worth of meds, i am actually worse off than when I first starting taking the 'so-called' AD's.
>
The only other thing I could suggest would be to fake pain in order to get the hydrocodone forthat (provided that hydrocodone is safe to take chronically). It's ridiculous that you should have to do that, but you have to look out for your best interests.> _____________________
Said i wouldn't steal, am not sure how convincing a liar i might be, plus i really respect my GP and would feel pretty bad about doing it.
Thanks again for your interest
Doug B
Posted by dougb on March 29, 2001, at 12:57:48
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Fred Potter on March 28, 2001, at 17:12:26
Thanks Fred
When i approached the doctor, i gave him print outs with supporting evidence for Buprenorphine, an opiate with all the fun removed, used in treating addicts.
> I made the mistake of telling the social worker (yes social worker) I had felt wonderful on it. Tut! We can't have that.Yeah, and just why is that. Major Depression is a sometime terminal illness, it would seem that, considering that possible outcome, anything they can do to make the inmates a little more comfortable would be a *good* thing.
Doug
Posted by dougb on March 29, 2001, at 13:05:06
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by PhoenixGirl on March 28, 2001, at 16:53:32
PGirl:
Thanks for your replySorry to read about _your_ bad experience. My father used to say: "Doug, if you don't feel that you can trust your doctor, get a new one."
Another thing we tend to lose sight of; Many Dr.'s don't really care about your problems, they were just taught a nice 'bedside' manner in Med school. They're in it for the _____ (you get 3 guesses here)
Keep your chin up and cancel your check, that way you both can have a similar experience...
> The only possible problem I can see would be > if you had to keep raising the dose to keep
> the same effectiveness, and ended up
> addicted.
I have, of course, no interest in further screwing up my miserable little existence by getting addicted.When pdoc said the same thing i reminded him that my body is now somehow addicted to Zoloft, that i started with 50mg am now up to 300, when i have tried to go off of it (while i still have 2 neurons to rub togother), i got _real_ sick.
So the state is now paying for $400 worth of meds, i am actually worse off than when I first starting taking the 'so-called' AD's.
>
The only other thing I could suggest would be to fake pain in order to get the hydrocodone forthat (provided that hydrocodone is safe to take chronically). It's ridiculous that you should have to do that, but you have to look out for your best interests.> _____________________
Said i wouldn't steal, am not sure how convincing a liar i might be, plus i really respect my GP and would feel pretty bad about doing it.
Thanks again for your interest
Doug B
Posted by Elizabeth on March 30, 2001, at 4:17:11
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Fred Potter, posted by dougb on March 29, 2001, at 12:57:48
> Thanks Fred
>
> When i approached the doctor, i gave him print outs with supporting evidence for Buprenorphine, an opiate with all the fun removed, used in treating addicts.I wouldn't say all the fun is removed < g >. You can't get high off of bupe, but it does provide the sense of being "okay" that some of us have felt we were missing all our lives (this is probably what drives people to get addicted to heroin and heavier opiates). It allows us to appreciate the good things in life (IOW, to experience pleasure normally), and to feel we can deal with the bad things. It doesn't make you happy as such, certainly not euphoric; it does permit you to become happy when good things happen.
It also eliminates opiate cravings in addicted individuals, of course, and lacks major withdrawal symptoms. (Depression is the only serious one I experience.)
Posted by SLS on March 30, 2001, at 9:14:57
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 4:17:11
> > When i approached the doctor, i gave him print outs with supporting evidence for Buprenorphine, an opiate with all the fun removed, used in treating addicts.
> I wouldn't say all the fun is removed < g >. You can't get high off of bupe, but it does provide the sense of being "okay" that some of us have felt we were missing all our lives (this is probably what drives people to get addicted to heroin and heavier opiates). It allows us to appreciate the good things in life (IOW, to experience pleasure normally), and to feel we can deal with the bad things. It doesn't make you happy as such, certainly not euphoric; it does permit you to become happy when good things happen.
Hi Elizabeth.I hope all is well with you.
Are you still taking Parnate?
How long have you been taking buprenorphine, and how do you feel it has helped you? Would you consider yourself to be at all depressed at this point?
I hope you don't mind listing them, but I would like to know what medication you are currently taking and at what dosages. I am still nowhere near where I need to be to go back to work.
Thanks.
- Scott
Posted by dougb on March 30, 2001, at 11:46:36
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 4:17:11
Thanks Elizabeth:
What you describe is exactly what the Hydrocodone does for me, at the doasage mentioned.
It may sound counter-intuitive, but if i take too much, instead of feeling normal with energy to do all those little tasks that life requires, i feel sedated with diminished clarity of thought.
Now, you might think that my Dr. in the interest of science or whatever, might be interested in these and following observations.
Instead, he gets this kind of blank stare and goes back to filling out his paperwork or whatever the hell it is, he does when he sees me :-)
I guess he just thinks I'm babbling, eh Dr. B ;- ?
In any event, at the onset of a real bad spell, my whole body starts aching, Flu-like. Which i interpret as my endorphine receptors short-circuiting.
The body manufactures it's own opiates, The Endorphines, the purpose of which are pain control, pleasure and a state of mind we call 'well-being', amoung many others I'm sure.
Interestingly enough, the Alpha, Beta and Gamma endorphine receptors (the locks) are similar enough to the molecular structure (the keys), in the opiates, for the body to accept and use.
When I exercise for a vigorous and extended period of time (thus producing endorphines, i guess) I get euphoric to the point of giddiness.
All this, to my unwashed logic, seems connected:
no endorphines/or receptors not working right = -- > depression,Add opiate (artificial endorphines) = -- > 'well-being'/ healthy psyche.
But hey, - What is wrong with that picture?
Most likely, their are seperate receptors or sub-receptors controlling the different functions ie pain control, euphoria and well-being. And on and on.
The opiates must be like a shotgun, Buprenorphine a little less so and the future will most likely see drugs that will just a single receptor.
Medical wizards will then be able to complement seratonigenic therapy with a 'your-state-of-mind-is-now -- > _Well-Being_!
Thus breaking the 'i-feel-like ____', so i don't do anything, since i don't do anything, i-feel-like ____ spiral.
But, because your doctor has never been there, S/he can only guess at what severe chronic depression is like.
In a more enlightened era, we will recognize many addicts for what they are. Sick people sub-consciously seeking normalacy through self-medication, who have gotten bushwacked in their pursuit of well-being.
Disease = not being at-ease, i don't know about you but that is the understatement of the year when it comes to D.
Sorry to be so long winded, hope my thoughts somehow somewhere make a difference.
Anyway....
This begs the question; get hooked on hydro or whatever to 'earn' a script for a needed medecine?
Also ma'am, do you build up tolerance for this rx?, Thanks
If anyone else is still reading ;-)), what is the diference between Bupernorphine and Naltraxone?
And, do these drugs create a dependence of their own?
If so, how does their withdrawal compare to that of some of the so called AD's (Paxil, et. al)?
Thanks Doug B
Posted by dougb on March 30, 2001, at 12:54:11
In reply to Some thoughts on Opiates and depression » Elizabeth, posted by dougb on March 30, 2001, at 11:46:36
> >
_________________________________________
Mr Heroin Blues!
Honey,before you start fooling with me,
let me tell you how it will be.
I shall succeed and make you my slave.
Those stronger than you have gone to their grave.
You think you can never become a disgrace,
Ending up addicted to poppy seed waste.
So you start inhaling me one afternoon,
But into your veins I'll go very soon.
And once I have entered your vein,
the cravings for me will drive you insane.
You'll sell your bodu fora buck, and turn into something vile and corrupt,
And one day you'll realise the monster you've grown,
and solemly swear to leave me alone.
If you think you can master the mystical knack..
Sweetie try getting me off your back.
You'll vomit, you'll cramp, you'll tie in a knot.
Jangling your nerves will scream for a shot.
he how chills, the cold sweats, the withdrawal pains,
can only be stopped by little white grains.
There is no other way, and no need to look,
Deep down inside you know that you're hooked.
I warn you ahead, and so if you dare, it says in the contract
"till death do us part"
Author unknown.
___________________________________Sobering stuff.....
There is lot's more food for thought at the site:
http://www.drugaid.com.au/guestbook.htmlWas an addict once, not opiates, and let me tell you that if you wanted to go to Hell, you would first pass thru Depression, 3/4 of the way there, but when you got to the stinking little berg called Addiction you were just outside the gates.
If you haven't been there yet, don't bother it ain't worth the trip....(And that IS the understatement of the year)
Doug B
Posted by Mr. Scott on March 30, 2001, at 15:27:36
In reply to ML Opiates and Treatment resistant Psychiatrists, posted by dougb on March 28, 2001, at 16:12:14
Yes... See one of my doctors.. Last time I was in there he tried to get my to take MSContin (Morphine) or at the very least Vicodin..
I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
Posted by Elizabeth on March 30, 2001, at 20:15:28
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by SLS on March 30, 2001, at 9:14:57
> Hi Elizabeth.
Hi!
> I hope all is well with you.
Getting there.
> Are you still taking Parnate?
Yes, but just 30mg/day.
> How long have you been taking buprenorphine, and how do you feel it has helped you?
How long...hmm, I must have started it again around Christmas, so that would be 3 months, not counting the time I was in the hospital (3 weeks -- different thread).
It helps tremendously with negative symptoms, such as anhedonia and anergia, that the Parnate doesn't touch. It also lifts my mood, of course. (I don't know at what dose the ceiling effect occurs, but I am apparently nowhere near it.) And, although this effect seems to be unique to me, it is very activating with no period of sedation or "nodding."
The side effects are a big down side, and I do worry about tolerance. Supposedly, delta antagonists can prevent tolerance. I wonder if anybody is working on developing a mixed mu agonist/delta antagonist?
> Would you consider yourself to be at all depressed at this point?
I'm not at 100% yet, no. A problem with bupe for me is that it's short-acting, so I get a lot of ups and downs throughout the day. Another problem is that the disastrous condition of the stock market has led many manufacturers to cut down production of drugs, and unusual drugs like bupe are the first ones to go, so I've been having a hard time finding it. (Most pharmacies don't carry it, of course, but now I'm finding that the wholesalers are all out of it too.)
> I hope you don't mind listing them, but I would like to know what medication you are currently taking and at what dosages. I am still nowhere near where I need to be to go back to work.
I know what you mean.
Parnate 10mg tid
buprenorphine 0.3mg tid
Claritin 20mg qd
docusate 100mg tid
iron and calcium supplements
Metamucil whenever possible
a bunch of random stuff prn
Posted by ShelliR on March 30, 2001, at 21:00:29
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 20:15:28
Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
p.s. HI SCOTT!
Posted by ShelliR on March 30, 2001, at 21:04:47
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Mr. Scott on March 30, 2001, at 15:27:36
>
> I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.Mr. Scott,
Do you live in the Boston area? Do you know any more about exactly how mass general has been trying a lot "of this opiod depression stuff"? Are there controlled studies going on there? Thank you for any information. Shelli
Posted by SLS on March 31, 2001, at 10:11:22
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on March 30, 2001, at 20:15:28
Thank you, Elizabeth.
:-)
- Scott
> > I hope you don't mind listing them, but I would like to know what medication you are currently taking and at what dosages. I am still nowhere near where I need to be to go back to work.
>
> I know what you mean.
>
> Parnate 10mg tid
> buprenorphine 0.3mg tid
> Claritin 20mg qd
> docusate 100mg tid
> iron and calcium supplements
> Metamucil whenever possible
> a bunch of random stuff prn
Posted by dougb on March 31, 2001, at 12:00:23
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Mr. Scott on March 30, 2001, at 15:27:36
> Yes... See one of my doctors.. Last time I was in there he tried to get my to take MSContin (Morphine) or at the very least Vicodin..
>
> I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.Mr. Scott:
Thank you for your reply.Am in Texas, but if you would kindly give me your Dr.'s name and phone number, will contact.
Doug B
Posted by ShelliR on March 31, 2001, at 12:55:36
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Mr. Scott, posted by dougb on March 31, 2001, at 12:00:23
> > I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
>
> Mr. Scott:
> Thank you for your reply.
>
> Am in Texas, but if you would kindly give me your Dr.'s name and phone number, will contact.
>
> Doug BDoug B, I'm completely confused. Are you also Mr. Scott?
Why would I give a stranger on the internet my Dr.'s name and number? I was interested in checking if there are studies on opiates at mass general. My post was directed to Mr. Scott. Why did you answer my post? You've completely lost me. ShelliR
Posted by Mr. Scott on April 1, 2001, at 11:30:28
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by ShelliR on March 30, 2001, at 21:04:47
> >
> > I don't know where your at (geography) but I understand Mass General has been trying a lot of this opiod depression stuff.
>
> Mr. Scott,
> Do you live in the Boston area? Do you know any more about exactly how mass general has been trying a lot "of this opiod depression stuff"? Are there controlled studies going on there? Thank you for any information. ShelliHi Shelli,
Actually No I live in Chicago. My Doc who is wishing to try Opioids told me that Mass General is the cutting edge facility working on the Opioid treatment of depression. I haven't even begun lokking into it yet, but When I find some info I will post.
mrscott
Posted by dougb on April 1, 2001, at 15:09:34
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » dougb, posted by ShelliR on March 31, 2001, at 12:55:36
> Doug B, I'm completely confused. Are you also Mr. Scott?
No but there must be a good multiple personality joke here somewhere :-)
>
> Why would I give a stranger on the internet my Dr.'s name and number?
Of course you would not, there is a mix up here...
When i look back at the message thread, i see no message from me to you. Re-read the message in question and see if that does not clarify.As i am directing a message to you, you should see a subject line like this:
Re: Blah Blah > >SheliR
Sincerely
Doug B
Posted by Elizabeth on April 5, 2001, at 7:43:53
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by ShelliR on March 30, 2001, at 21:00:29
> Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
Hi Shelli. There are 3 different types of opioid receptors (that we know of at present, at least), named mu, kappa, and delta (there are also subtypes of these, e.g. mu-1 and mu-2, but let's not get into that). Activation of the mu receptor is responsible for most of the beneficial effects that opioids are known for. Kappa agonists (e.g., Stadol) also have some analgesic action, moreso for women than for men. The delta receptor may also have something to do with relieving pain, but it also seems to be involved in the development of tolerance. Most of the opioids currently marketed for pain are nonselective agonists at all three subtypes. There are a few exceptions, including buprenorphine (Buprenex), butorphanol (stadol), nalbuphine (Nubain), and pentazocine (Talwin).
Buprenorphine is officially labelled for pain, but it's perfectly legal for doctors to prescribe it for off-label uses including depression. (This applies in the U.S., other countries may have different rules.)
Posted by ShelliR on April 5, 2001, at 12:34:52
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on April 5, 2001, at 7:43:53
> > Hi Elizabeth. What is a delta antagonist? Also is buprenorphine "allowed" to be prescribed for depression? Thanks, Shelli
>
> Hi Shelli. There are 3 different types of opioid receptors (that we know of at present, at least), named mu, kappa, and delta (there are also subtypes of these, e.g. mu-1 and mu-2, but let's not get into that). Activation of the mu receptor is responsible for most of the beneficial effects that opioids are known for. Kappa agonists (e.g., Stadol) also have some analgesic action, moreso for women than for men. The delta receptor may also have something to do with relieving pain, but it also seems to be involved in the development of tolerance. Most of the opioids currently marketed for pain are nonselective agonists at all three subtypes. There are a few exceptions, including buprenorphine (Buprenex), butorphanol (stadol), nalbuphine (Nubain), and pentazocine (Talwin).
>
> Buprenorphine is officially labelled for pain, but it's perfectly legal for doctors to prescribe it for off-label uses including depression. (This applies in the U.S., other countries may have different rules.)Thanks Elizabeth for the information. I just went to a new pdoc yesterday and he approved my small amount to hydrocodeine (about 3.75mg per day). He says, however, he cannot prescribe it for me because you can not prescribe it for depression. Right now I am getting it from my gyn for premenstral pain.
When I read what you wrote I wondered if I should be talking about buprenorphine or some other form of opiate with my doctor. However, I don't believe he is much of a specialist in this and I am so grateful to find a pdoc who can accept that I take this, that I don't know if I want to push it any further.
Perhaps along the line it ought to be a neurologist I consult with? It seems the main reason you suggest not using codeine because of the higher risk of addiction which I have not experienced yet, after three years, but of course I cannot rule it out in the future. shelli
Posted by SLS on April 5, 2001, at 12:52:08
In reply to Re: ML Opiates and Treatment resistant Psychiatrists, posted by Elizabeth on April 5, 2001, at 7:43:53
Hi Elizabeth.
It never ceases to amaze me the diversity of unconventional treatments appearing on Psycho-Babble. I started seeing a new doctor in September. Since he came highly recommended, I am hoping that he would be cognizant of and motivated to use some of these things. So far, he has not revealed any "exotic" treatments that he has alluded to. Right now, he is focusing on exploring a few combinations of standard antidepressants that I have not yet given a truly adequate trial. That's OK with me for now.
I told my doctor about the use of hydrocodone by people here and asked him how often it was used for depression, and if it exerted a true antidepressant effect. His answer was that he thought the perceived relief from depression using hydrocodone was a euphoriant effect no different from that which would be experienced by an otherwise healthy person.
I guess my question is this: Whose idea was it to try buprenorphine? If it was yours, how did you go about selling it to your doctor? Where did you get the idea from?
Thanks.
- Scott
Posted by Elizabeth on April 5, 2001, at 20:55:50
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by ShelliR on April 5, 2001, at 12:34:52
> Thanks Elizabeth for the information. I just went to a new pdoc yesterday and he approved my small amount to hydrocodeine (about 3.75mg per day). He says, however, he cannot prescribe it for me because you can not prescribe it for depression. Right now I am getting it from my gyn for premenstral pain.
Hi. I think you probably mean either hydrocodone or dihydrocodeine, right? If your doctor is licensed in the U.S., I'm a little confused by his claim that he can't prescribe it for depression. He might not want to because it's an unusual use, but I don't know of any legal reason why he couldn't if he wanted to.
> When I read what you wrote I wondered if I should be talking about buprenorphine or some other form of opiate with my doctor. However, I don't believe he is much of a specialist in this and I am so grateful to find a pdoc who can accept that I take this, that I don't know if I want to push it any further.
I know, I sort of feel the same way, like I don't have a right to ask my doctor about alternatives to buprenorphine because he is already doing me a favour by prescribing that. This isn't true, of course -- we should feel like we can speak to our doctors freely, right? -- but it still feels awkward. (Personally I think the government shouldn't interfere so much with doctors' ability to make medical decisions.)
> Perhaps along the line it ought to be a neurologist I consult with? It seems the main reason you suggest not using codeine because of the higher risk of addiction which I have not experienced yet, after three years, but of course I cannot rule it out in the future. shelli
A neurologist won't treat depression (except maybe if it's related to a problem, such as epilepsy or stroke, that the neurologist is already treating), and almost certainly won't be willing to use unconventional treatments. The ideal person to see would be a pdoc who has experience with opiates (using them to treat patients, that is!). The only other thing I can think of would be maybe a pain specialist, since they tend to have more experience prescribing opiates than psychiatrists do.
I really don't think using opiates is the best way to treat depression at all, if you can find anything else that works, but I've tried all the standard things and then some and there just doesn't seem to be any alternative (except ECT, but I very much prefer to avoid that).
Posted by Elizabeth on April 5, 2001, at 21:23:17
In reply to Re: ML Opiates and Treatment resistant Psychiatrists » Elizabeth, posted by SLS on April 5, 2001, at 12:52:08
> It never ceases to amaze me the diversity of unconventional treatments appearing on Psycho-Babble.
Well, this isn't so unconventional. Opiates are really the first drugs that were used as ADs, dating back to ancient times.
> I started seeing a new doctor in September. Since he came highly recommended, I am hoping that he would be cognizant of and motivated to use some of these things. So far, he has not revealed any "exotic" treatments that he has alluded to.
I hope that if he does give you more of an idea of what he considers "exotic," you'll share his ideas with us!
> Right now, he is focusing on exploring a few combinations of standard antidepressants that I have not yet given a truly adequate trial. That's OK with me for now.
That's good. It makes sense for him to want to do that, and it also gives him a chance to get to know you. A doctor is more likely to feel comfortable prescribing controlled substances to a patient he knows pretty well.
> I told my doctor about the use of hydrocodone by people here and asked him how often it was used for depression, and if it exerted a true antidepressant effect. His answer was that he thought the perceived relief from depression using hydrocodone was a euphoriant effect no different from that which would be experienced by an otherwise healthy person.
I agree with part of what he's saying. Morphine and other opioid agonists are mood-elevating drugs, and they have this effect on nondepressed and depressed people alike. (They don't do it for everybody, BTW, so don't expect miracles.)
But as for the "euphoriant" part, I don't take a high enough dose to produce euphoria (if that's even possible with buprenorphine, something that's disputed). It doesn't feel like getting high, nor am I tempted to take more in order to try to get high.
I also think that some depressed people probably have problems that are particularly responsive to opiates and less responsive to monoaminergic ADs. One explanation might be a deficit of endogenous opioids (I have no doubt that this is oversimplified, if not outright wrong). Anyway, this is based on my own experience.
> I guess my question is this: Whose idea was it to try buprenorphine? If it was yours, how did you go about selling it to your doctor? Where did you get the idea from?
My pdoc isn't a specialist in psychopharmacology (he's actually a psychoanalyst), although I think he's still better than most psychopharmacologists < g >. So at one point, when it became clear that Nardil had stopped working, he sent me to a specialist, someone he knew from residency. The specialist happens to be a researcher who focuses on novel treatments for depression, and buprenorphine was one of the treatments he had experimented with (1). He mentioned it as a possibility because of some of the things I said about my symptoms, but he felt at the time that it would be worthwhile to try MAOIs again or consider tricyclics (which I've never been able to tolerate very well). Anyway, eventually my pdoc and I came to a point where I was doing having trouble functioning on a day-to-day basis and nothing seemed to be helping, so we decided to try buprenorphine. It appealed to me in particular because I was pretty sure it would work (based on past experiences with hydrocodone from my dentist I knew that I'm one of the people who feel better on opiates -- as I said, not everybody does), and it was something that would work pretty much immediately (it takes an hour rather than a month).
(1) Bodkin et al. Buprenorphine treatment of refractory depression. _Journal of Clinical Psychopharmacology_ 1995 Feb; 15(1):49-57.
Posted by SLS on April 6, 2001, at 8:08:38
In reply to opiates -- Scott, posted by Elizabeth on April 5, 2001, at 21:23:17
Elizabeth,
Thanks for taking the time to respond. You have cleared up quite a bit for
me. I am much more comfortable with the approach my doctor is taking. That
means a lot.Thanks again.
- Scott
> > I guess my question is this: Whose idea was it to try buprenorphine?
If it was yours, how did you go about selling it to your doctor? Where did
you get the idea from?> My pdoc isn't a specialist in psychopharmacology (he's actually a
psychoanalyst), although I think he's still better than most
psychopharmacologists < g >. So at one point, when it became clear that
Nardil had stopped working, he sent me to a specialist, someone he knew
from residency. The specialist happens to be a researcher who focuses on
novel treatments for depression, and buprenorphine was one of the
treatments he had experimented with (1). He mentioned it as a possibility
because of some of the things I said about my symptoms, but he felt at the
time that it would be worthwhile to try MAOIs again or consider tricyclics
(which I've never been able to tolerate very well). Anyway, eventually my
pdoc and I came to a point where I was doing having trouble functioning on
a day-to-day basis and nothing seemed to be helping, so we decided to try
buprenorphine. It appealed to me in particular because I was pretty sure
it would work (based on past experiences with hydrocodone from my dentist
I knew that I'm one of the people who feel better on opiates -- as I said,
not everybody does), and it was something that would work pretty much
immediately (it takes an hour rather than a month).> (1) Bodkin et al. Buprenorphine treatment of refractory depression.
_Journal of Clinical Psychopharmacology_ 1995 Feb; 15(1):49-57.
Posted by dougb on April 6, 2001, at 16:14:15
In reply to opiates -- Shelli, posted by Elizabeth on April 5, 2001, at 20:55:50
> > approved my small amount to hydrocodeine (about 3.75mg per day).
Be carful that it does not come with a secondary analgesic that might have unwanted side effects.
One of the common combinations is Hydrocodone with acetaminophen.
Acetaminophen (Tylenol)is not good stuff to be taking for extended durations or elevated quantities where it is considered as poisonous:
http://www.lef.org/protocols/prtcl-001.shtml
> -- we should feel like we can speak to our doctors freely, right? -- but it still feels awkward.If your use is legitimate, why? Hydrocodone, according to RXlist.com is the fifth most prescribed rx in the country:
If you still feel squeemish about the subject, check out this page and it's excellent links for lots of good info and tips on dealing with your Dr.:
http://www.widomaker.com/~skipb/2ThePatient.html
It worked for me! My GP prescribed the Hydrocodone as requested.He brought up the subject of dependence, and i pointed out how I am already quite dependent on several AD's but am not really being helped by them
An $18.00 prescription is doing a lot more for me than hundreds for the Zoloft/Remeron/Atavan mix.
The treatment of choice for Depression since Hippocrates up until the 1950's has been one of the opiate class of drugs:
The Therapist/webmaster for the above site has some unorthodox points of view - maybe s\he is just ahead of her time.
> I really don't think using opiates is the best way to treat depression at all,
What is your unhappiness with your outside of the frequent dosing, you mentioned?
Doug B
Posted by ShelliR on April 6, 2001, at 18:49:31
In reply to Re: opiates -- Shelli » Elizabeth, posted by dougb on April 6, 2001, at 16:14:15
Doug and Elizabeth. Thanks so much for the information and support about taking opiates for depression.
Elizabeth, I very much agree that opiates are not the best choice for an antidepressant for most people.
I came to this board about a year ago, specifically asking about opiates because they seemed to be the only thing that relieved by depression at that point. I had taken them for two years without any increase. I had had a very successful run with nardil for many years, but finally last year, back to the depths again.
I had made the connection between opiates and lack of depression when I was given some for a muscle spasm in the center of my stomach, which took a while to be diagnosed as nothing internal. (Then a simple shot with a tiny bit of cortizone got rid of the pain).
In the last few years the combination of nardil and lamictal did work for me, but this last time I gained 15 lbs on the lamictal. (All while doing the treadmill,
weights, and watching my diet. And I lost it all within two weeks of going off of lamictal).It's was hard for my therapist or my pdoc to understand why being overweight was so awful to me. I am also diagnosed with a dissociative disorder, and things
to me do not always look like they do to other people, and I was developing a real adversion to my body.I think I tried about fifteen different combinations of nardil with something else, until I just refused to try anything else. I lost a lot of time this year to sleeping and
feeling disoriented and I felt enough!So I am extremely grateful to both of you for sharing that you also take opiates and it is approved by your doctors. Elizabeth, I did pick up along the way, that as
you said, not everyone has the same positive reaction to opiates and also there is a threshold over which I will feel nausea, instead of feeling good--normal.
Hydocodene can make me a bit high if I take too much, but so does alcohol, and yet I choose in general not to drink or overtake hydrocodone because I'd rather
be more grounded than high.Incidently, I also had a differerent reaction to valium than many people. It totally grounds me--I could be totally floating and not feeling my body from being
dissociative and I could always count on valium to bring me back. Friends of mine without dissociative disorders have the opposite reaction--it makes them sort of
spacey. Now valium also has a bad rap and doctors want to give me klonpin instead, but it doesn't have the same grounding effect for me.About doctors prescribing opiates: My gyn said that in the list of doctors that lose their licenses, the greatest number lose it due to overprescribing opiates. She
said doctors are very carefully watched re opiate prescriptions. She said she would be more comfortable giving me tylenal 3, but I really pushed for straight hydrocodone.She is a very down to earth woman and a really good doctor, so I am confused to have both of you say that there is no problem for doctors to prescribe optiates for depression.
Anyway, thanks for letting me go off, and thanks to both of you for your support and information.
Shelli
Posted by judy1 on April 6, 2001, at 21:05:20
In reply to Re: opiates Elizabeth, Doug- Long (Too long!), posted by ShelliR on April 6, 2001, at 18:49:31
Hi Shelli,
I'm happy to see the support you've gotten for your use of an opiate for an AD. I think I've mentioned my pdoc is willing to prescribe 'small amounts' as an AD or anxiety med- but he is most definitely in the minority. I also agree that people react differently to it, I was interested to read you have a dissociative disorder (like me) and I also respond well to hydrocodone. Just an aside, I get Norco 10/325 to keep the level of APAP down. While I agree with one of the posters that lying about pain isn't really a decent thing to do, I feel depression is a lot worse. take care, judy
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