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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 39 to 63 of 77. Go back in thread:
Posted by MoQ on December 19, 2002, at 16:39:59
In reply to Re: treatment resistant depression -Suggestions? » SLS, posted by shelliR on March 18, 2002, at 20:39:09
Hi there! I am new to posting on this board, although have been reading it at length over the past month or so. I won't go into my 10+ year of treatment-resistant depression, but will say that I was extremely relieved (and, I must admit, excited) to find this site. I am coming in a different door, I know, because I am still unsure of my navigational skills in here, but Shelli, I really wanted to make sure I was in contact with you as you have the same views I do with regard to using Vicodin (or other opiates) in the treatment of depression that has just not responded to several different trials of anti-depression meds. I thought I was the only one who experienced incredible symptom relief with the use of two one-half tablet doses of Vicodin daily. I found out how well I responded to this opiate several years ago and have used it off and on (in very small amounts) in connection with injuries and hospital stays for a couple of surgeries. I am very fortunate to have a psychiatrist I have been going to for ten years that respects my opinion and really listens to my concerns. After sending her quite a bit of information (mainly from this site), she referred me to a psychopharmacologist. My initial consult with him is in January (2003). My question is this: Does anyone know of any other research articles/links I can go to in order to be as well prepared and informed as possible when I have my appointment? Thank you in advance to any and all who can assist me in this regard!
Posted by ShelliR on December 19, 2002, at 21:15:51
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
Dear MoQ,
I was very much like you when I first started taking vicodin: for several years a very small amount took care of my depression when my AD didn't work. First only premenstrually, then all the time. But my story sort of goes downhill, so be careful.
I was put on oxycontin instead of vicodin, because this new psychiatrist thought it was better because it lasted longer. I got habituated very quickly and had to go up and up until I no longer could afford it. Now I'm on methadone, which doesn't have as good an effect, but is a lot cheaper. But even with the methadone, in order for it to be effective, I'm on a large dose, and unless I keep increasing, it loses its effectiveness for my depression.
If I had to do it all over again, I wouldn't bother finding a psychiatrist to prescribe opiates. I'd get it from a pain doctor and I would stick with the vicodin--the very least I could get away with. I think the oxycontin really messed me up because now even a large dose of vicodin does nothing.
There's a woman on this board, Elizabeth. I'm sure you've run into her posts about buprenorphine if you're doing searches on opiates and depression. She was able to get it from her psychiatrists, but it is only available in liquid form for injections. She uses it intranasally. It was supposed to go on the market here in a sublingual form as an alternative to methadone, but they've put it off at least a year. It's a partial opiate and seems to help people not crave heroin--like methadone. There was a small study on it http://www.biopsychiatry.com/bupref.html-that's an abstract, but I know the whole study is on the internet. Buprenorphine is also "addictive", really the right word is "habituating".
The other bad thing about using opiates for depression is that if you have to go into a hospital, they treat you like shit, like you are a street addict. I kept blacking out from the large doses of effexor they were giving me, but they blamed it on coming off the oxycontin, so they couldn't care less. Anyway, if it's the only thing that works for you, I would go for it, but I'd be surprised if you'll get any support from a psychopharmacologist. The guys from the study no longer prescribe it because they were sued by someone who blamed their dependence on buprenorphine on them.
Sorry, for the bad news, but it's important to know what you may be getting yourself in to. Still, while I am trying other ADs, and homeopothy and acupuncture, I am still taking methadone, because it has kept me alive. Just be careful.
Shellli
Posted by linkadge on December 20, 2002, at 9:29:32
In reply to Re: Use of opiates in treating depression » MoQ, posted by ShelliR on December 19, 2002, at 21:15:51
Are you in a place where you can
do an intense physical workout?I knew from the beginning that opiates
were very effective for my mood. Tylenol
3 (codine) for wizdom teeth was very mood elevating. I really think some people have
a disturbance in the endorphin system,
hense my hypersensitivity to pain. I feel
like I will just fall apart all the time.While the Celexa really helps, the only thing
that has put me in a place of feeling very
good, was extreme arobic excercise. It sounds
basic, but research shows heroin habits are
very rarely broken without some type of
intense physical workout.Linkadge
Posted by BrittPark on December 20, 2002, at 23:52:22
In reply to This may sound trivial but, posted by linkadge on December 20, 2002, at 9:29:32
A large percentage of people respond well to opioids, depressed or not. I've generally looked forward to things like wisdom teeth being pulled because I know I'll be on vicodin for a day or two. The improvement in mood that I get (and I believe many others get) is remarkable. Indeed before the discovery of the first antidepressants opioids were commonly prescribed for depression.
The problem with opioids is tolerance. Almost everyone develops it sooner or later. So if you're going to use opioids to treat depression, take as little as possible and as mild as possible an opiod. In addition take opioid holidays. I don't know how long they would have to be, and they wouldn't feel like holidays. Other possibilities are mixed agonist antagonists like buprenorphine, which is supposed to produce less tolerance, or tramadol a very week opioid that is also supposed to produce less tolerance.
There is some possibly very good news coming from a company called Pain Therapeutics who are in clinical trials of two drugs, one a morphine formulation and one an oxycodone formulation. The trick of these new drugs is they contain very small amounts of an opioid antagonist (I'm not sure whether it is naloxone or naltrexone). On the surface it sounds silly, but the researchers who founded the company found that the addition of microdoses of antagonists with opiod agonists not only improved analgesia in rats but seemed to block the development of tolerance. Now Murphy's law says that along with the lack of tolerance will come lack of euphoria :( I hope not though.
By the way I do take vicodin for depression at 5/500 in the evening. My psychiatrist prescribes it. I think that if I could take 3 or 4 5/500s a day without becoming tolerant it would eliminate the rest of my depression. Alas, vicodin doesn't work that way, at least for me.
In hopes of better living through better chemistry,
Britt
Posted by judy1 on December 21, 2002, at 11:05:54
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
I'm glad you have found relief with such a small dose of hydrocodone daily- it is what my shrink prescribes for some of his panic/depressed patients. Personally I couldn't agree more with Shelli's post- it is a LOT easier going through a pain doc, I get ms contin (morphine) that way. Because I have bipolar disorder, my depresssions tend to be self-limiting and opiate treatment works really well in that setting because I don't have to keep upping the dose to get the same effect. I wonder if you have anxiety symptoms?, I ask because hydrocodone (vicodin) is a great anxiolytic drug too, and since you are getting such a robust response from a relatively low dose perhaps that is why. take care, judy
Posted by jimmygold70 on December 21, 2002, at 12:21:01
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
Why mess with opiates? I'd bet you didn't try all treatment options.
My protocol:
1) SSRI
2) Raise Dose
3) Switch SSRI with same higher dose
4) Add Edronex (or if not tolerated, move to high dose Effexor)
5) SSRI+Edronax+Remeron or Effexor+Remeron
6) Add Lamictal
7) Add Lithium
8) Add amantadine (Symmestrel)
9) ECT
10) MAO Inhibitor (Nardil/Parnate)
11) Going to a well known psychopharmacologist and staying there for a year+This works for 98% of depressed...
Jimmy
10)
Posted by MoQ on December 29, 2002, at 10:31:40
In reply to Re: Use of opiates in treating depression » MoQ, posted by ShelliR on December 19, 2002, at 21:15:51
> Dear MoQ,
>
> I was very much like you when I first started taking vicodin: for several years a very small amount took care of my depression when my AD didn't work. First only premenstrually, then all the time. But my story sort of goes downhill, so be careful.
>
> I was put on oxycontin instead of vicodin, because this new psychiatrist thought it was better because it lasted longer. I got habituated very quickly and had to go up and up until I no longer could afford it. Now I'm on methadone, which doesn't have as good an effect, but is a lot cheaper. But even with the methadone, in order for it to be effective, I'm on a large dose, and unless I keep increasing, it loses its effectiveness for my depression.
>
> If I had to do it all over again, I wouldn't bother finding a psychiatrist to prescribe opiates. I'd get it from a pain doctor and I would stick with the vicodin--the very least I could get away with. I think the oxycontin really messed me up because now even a large dose of vicodin does nothing.
>
> There's a woman on this board, Elizabeth. I'm sure you've run into her posts about buprenorphine if you're doing searches on opiates and depression. She was able to get it from her psychiatrists, but it is only available in liquid form for injections. She uses it intranasally. It was supposed to go on the market here in a sublingual form as an alternative to methadone, but they've put it off at least a year. It's a partial opiate and seems to help people not crave heroin--like methadone. There was a small study on it http://www.biopsychiatry.com/bupref.html-that's an abstract, but I know the whole study is on the internet. Buprenorphine is also "addictive", really the right word is "habituating".
>
> The other bad thing about using opiates for depression is that if you have to go into a hospital, they treat you like shit, like you are a street addict. I kept blacking out from the large doses of effexor they were giving me, but they blamed it on coming off the oxycontin, so they couldn't care less. Anyway, if it's the only thing that works for you, I would go for it, but I'd be surprised if you'll get any support from a psychopharmacologist. The guys from the study no longer prescribe it because they were sued by someone who blamed their dependence on buprenorphine on them.
>
> Sorry, for the bad news, but it's important to know what you may be getting yourself in to. Still, while I am trying other ADs, and homeopothy and acupuncture, I am still taking methadone, because it has kept me alive. Just be careful.
>
> ShellliThanks so much for your kind response. I was a bit hurt by the first response I saw from someone who basically accused me of not doing everything I could, by using the words "I bet you haven't...." Wow, that was kind of a shocker because it took up quite a bit of courage to post anything at all and everyone had seemed so supportive. Anyway, it made me feel better to get your response (who needs to be kicked when they're down, right?). Anyway, the only thing I am open to at this point is the Vicodin in small doses. I do not want to get involved with OxyContin or Methadone as I know there is an extremely high risk of the negatives far outweighing the positives. Thanks again and all my best to you and your ongoing recovery.
Posted by MoQ on December 29, 2002, at 10:50:34
In reply to Re: Use of opiates in treating depression » MoQ, posted by judy1 on December 21, 2002, at 11:05:54
> I'm glad you have found relief with such a small dose of hydrocodone daily- it is what my shrink prescribes for some of his panic/depressed patients. Personally I couldn't agree more with Shelli's post- it is a LOT easier going through a pain doc, I get ms contin (morphine) that way. Because I have bipolar disorder, my depresssions tend to be self-limiting and opiate treatment works really well in that setting because I don't have to keep upping the dose to get the same effect. I wonder if you have anxiety symptoms?, I ask because hydrocodone (vicodin) is a great anxiolytic drug too, and since you are getting such a robust response from a relatively low dose perhaps that is why. take care, judy
Thank you, thank you, thank you! I had just responded to Shelli, indicating my appreciation of how supportive she was. The first response I opened had come across (at least to me) as accusatory rather than offering suggestions. I do have anxiety disorder with panic attacks, as well as depersonalization (which is the most horrible experience ever!! Luckily this doesn't happen as much). I haven't had to up the dosage at all. I do have benzos, which I have never abused, and my husband recreationally smokes pot, but I have absolutely no interest in that. I also drink maybe four times a year, two drinks each occasion. My point that I am trying to make to people (without being judged--and you and Shelli have certainly NOT judged me), is that I am not on a search for a legal high. I read somewhere that someone indicated doctors are afraid someone will become addicted to a narcotic, but aren't we all addicted to antidepressants? If something is available that improves my quality of life and takes away the terrible suffering and feelings of suicide, then why on earth is it not available? Anyway, your feedback was much appreciated! Take care!
Posted by MoQ on December 29, 2002, at 10:55:39
In reply to This may sound trivial but, posted by linkadge on December 20, 2002, at 9:29:32
> Are you in a place where you can
> do an intense physical workout?
>
> I knew from the beginning that opiates
> were very effective for my mood. Tylenol
> 3 (codine) for wizdom teeth was very mood elevating. I really think some people have
> a disturbance in the endorphin system,
> hense my hypersensitivity to pain. I feel
> like I will just fall apart all the time.
>
>
>
> While the Celexa really helps, the only thing
> that has put me in a place of feeling very
> good, was extreme arobic excercise. It sounds
> basic, but research shows heroin habits are
> very rarely broken without some type of
> intense physical workout.
>
> Linkadge
>
>Nothing is trivial, I appreciate any and all information! I know that exercise is supposed to produce endorphins, and I agree that I should indeed get more exercise. I am deconditioned but am in good physical shape for working out (low cholesterol, low blood pressure, normal body weight, etc.). I did want to comment on one thing, however, and that is how odd I find it that THE ONLY THING that elevates my mood is the Vicodin. Tylenol with codeine does absolutely nothing. Isn't that weird? I am just becoming convinced that people's brains can be wired very differently and in some cases respond differently to certain medications. Thanks again for your always welcome input!
>
>
>
Posted by MoQ on December 29, 2002, at 10:58:39
In reply to Re: opioids, posted by BrittPark on December 20, 2002, at 23:52:22
> A large percentage of people respond well to opioids, depressed or not. I've generally looked forward to things like wisdom teeth being pulled because I know I'll be on vicodin for a day or two. The improvement in mood that I get (and I believe many others get) is remarkable. Indeed before the discovery of the first antidepressants opioids were commonly prescribed for depression.
>Thanks for your response! Until I found this site I thought I was completely alone in this reaction. Take care!
> The problem with opioids is tolerance. Almost everyone develops it sooner or later. So if you're going to use opioids to treat depression, take as little as possible and as mild as possible an opiod. In addition take opioid holidays. I don't know how long they would have to be, and they wouldn't feel like holidays. Other possibilities are mixed agonist antagonists like buprenorphine, which is supposed to produce less tolerance, or tramadol a very week opioid that is also supposed to produce less tolerance.
>
> There is some possibly very good news coming from a company called Pain Therapeutics who are in clinical trials of two drugs, one a morphine formulation and one an oxycodone formulation. The trick of these new drugs is they contain very small amounts of an opioid antagonist (I'm not sure whether it is naloxone or naltrexone). On the surface it sounds silly, but the researchers who founded the company found that the addition of microdoses of antagonists with opiod agonists not only improved analgesia in rats but seemed to block the development of tolerance. Now Murphy's law says that along with the lack of tolerance will come lack of euphoria :( I hope not though.
>
> By the way I do take vicodin for depression at 5/500 in the evening. My psychiatrist prescribes it. I think that if I could take 3 or 4 5/500s a day without becoming tolerant it would eliminate the rest of my depression. Alas, vicodin doesn't work that way, at least for me.
>
> In hopes of better living through better chemistry,
>
> Britt
>
Posted by MoQ on December 29, 2002, at 11:09:56
In reply to Re: Use of opiates in treating depression, posted by jimmygold70 on December 21, 2002, at 12:21:01
> Why mess with opiates? I'd bet you didn't try all treatment options.
>
> My protocol:
> 1) SSRI
> 2) Raise Dose
> 3) Switch SSRI with same higher dose
> 4) Add Edronex (or if not tolerated, move to high dose Effexor)
> 5) SSRI+Edronax+Remeron or Effexor+Remeron
> 6) Add Lamictal
> 7) Add Lithium
> 8) Add amantadine (Symmestrel)
> 9) ECT
> 10) MAO Inhibitor (Nardil/Parnate)
> 11) Going to a well known psychopharmacologist and staying there for a year+
>
> This works for 98% of depressed...
>
> Jimmy
>
> 10)Just a quick FYI: I have tried #1, #2, #3, #4, #5, #6, and am now trying #11. The rest of the options (#7, 8, 9 and 10) were discussed with my psychiatrist of 11 years and her colleagues, and THEY recommended those were roads not to travel down. I am wondering if you are familiar at all with all of the studies that have been conducted regarding the positive anti-depressant effect(s) produced by SMALL AMOUNTS of opiates? (i.e., the fact that they were the medication of choice for depression up until the 1960's; that there has been extensive research conducted at hospitals such as one in Boston; and that there are researchers who are in the process of trying to develop medicinal agents that work with the use of an opiate ingredient). I am not "messing with opioids," I am trying to become as educated as possible on my condition and, after 11 years of suffering, am going through PROPER, MEDICAL channels to explore other treatment options, with the assistance of my doctor, psychiatrist, and now a psychopharmacologist. Perhaps you didn't mean to come across the way you did in your message, but, to say the least, I felt a bit attacked. You do not know my background or what courses of treatment I have undergone, and your tone was rather judgmental. I am just thankful there were other people who provided input, or I would have abruptly stopped looking for help on this site.
Posted by MoQ on December 29, 2002, at 11:21:07
In reply to Re: Use of opiates in treating depression » MoQ, posted by ShelliR on December 19, 2002, at 21:15:51
> Dear MoQ,
>
> I was very much like you when I first started taking vicodin: for several years a very small amount took care of my depression when my AD didn't work. First only premenstrually, then all the time. But my story sort of goes downhill, so be careful.
>
> I was put on oxycontin instead of vicodin, because this new psychiatrist thought it was better because it lasted longer. I got habituated very quickly and had to go up and up until I no longer could afford it. Now I'm on methadone, which doesn't have as good an effect, but is a lot cheaper. But even with the methadone, in order for it to be effective, I'm on a large dose, and unless I keep increasing, it loses its effectiveness for my depression.
>
> If I had to do it all over again, I wouldn't bother finding a psychiatrist to prescribe opiates. I'd get it from a pain doctor and I would stick with the vicodin--the very least I could get away with. I think the oxycontin really messed me up because now even a large dose of vicodin does nothing.
>
> There's a woman on this board, Elizabeth. I'm sure you've run into her posts about buprenorphine if you're doing searches on opiates and depression. She was able to get it from her psychiatrists, but it is only available in liquid form for injections. She uses it intranasally. It was supposed to go on the market here in a sublingual form as an alternative to methadone, but they've put it off at least a year. It's a partial opiate and seems to help people not crave heroin--like methadone. There was a small study on it http://www.biopsychiatry.com/bupref.html-that's an abstract, but I know the whole study is on the internet. Buprenorphine is also "addictive", really the right word is "habituating".
>
> The other bad thing about using opiates for depression is that if you have to go into a hospital, they treat you like shit, like you are a street addict. I kept blacking out from the large doses of effexor they were giving me, but they blamed it on coming off the oxycontin, so they couldn't care less. Anyway, if it's the only thing that works for you, I would go for it, but I'd be surprised if you'll get any support from a psychopharmacologist. The guys from the study no longer prescribe it because they were sued by someone who blamed their dependence on buprenorphine on them.
>
> Sorry, for the bad news, but it's important to know what you may be getting yourself in to. Still, while I am trying other ADs, and homeopothy and acupuncture, I am still taking methadone, because it has kept me alive. Just be careful.
>
> Shellli
By the way, thank you so much for the link you provided. I was able to garner a lot of information that may be useful in my ongoing quest. Thanks again!
Posted by Peter S. on December 30, 2002, at 14:21:11
In reply to Re: Use of opiates in treating depression, posted by MoQ on December 29, 2002, at 11:21:07
On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
Apparently doctors will be able to starat prescribing it starting this month.
Posted by Peter S. on December 30, 2002, at 14:27:12
In reply to Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:21:11
BTW a special waiver or advanced training is required in substance abuse in order for an MD to be allowed to dispense buprenorphine. There is a limit on the number of patients also.
Posted by BrittPark on December 30, 2002, at 14:32:50
In reply to Re: Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:27:12
> BTW a special waiver or advanced training is required in substance abuse in order for an MD to be allowed to dispense buprenorphine. There is a limit on the number of patients also.
Does anyone else detest the DEA as much as I do? ;)
Posted by BrittPark on December 30, 2002, at 14:48:41
In reply to Use of opiates in treating depression, posted by MoQ on December 19, 2002, at 16:39:59
You've probably found your references already. Here's another one: http://opioids.com/tramadol/tramadol.html
You may find other opioid positive abstracts on the same website.Cheers,
Britt
Posted by ShelliR on December 30, 2002, at 18:37:49
In reply to Buprenorphine Approved, posted by Peter S. on December 30, 2002, at 14:21:11
> On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
>
> Apparently doctors will be able to starat prescribing it starting this month.
Hi Peter,Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
Shelli
Posted by MoQ on December 30, 2002, at 19:04:46
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
> You've probably found your references already. Here's another one: http://opioids.com/tramadol/tramadol.html
> You may find other opioid positive abstracts on the same website.
>
> Cheers,
>
> Britt
>Thanks! I did actually find that one via a post that Shelli sent me, but all help is GREATLY appreciated!
Posted by MoQ on December 30, 2002, at 19:07:21
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>You know, I so wish that people would take some personal responsibility, don't you? I mean I work for a law firm and I know that a signed Release doesn't really carry all that much water anyway, but I would be willing to swear before a notary and anyone else who will listen that I promise to never sue my doctor for prescribing me something I ASKED FOR. My family physician had mentioned that doctors are now being sued by patients who asked for narcotic pain relievers and then turned around and blamed the doc for getting them "hooked." It's CRAZY!!!!
Posted by Peter S. on December 31, 2002, at 14:06:42
In reply to Re: Buprenorphine Approved » Peter S., posted by ShelliR on December 30, 2002, at 18:37:49
Hi Shelli,
I read in my local paper (Oakland Tribune) that it could be prescribed starting sometime in January of 03.
> > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> >
> > Apparently doctors will be able to starat prescribing it starting this month.
>
>
>
> Hi Peter,
>
> Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
>
> My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
>
> It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
>
> Shelli
>
Posted by MoQ on January 1, 2003, at 9:22:49
In reply to Re: Buprenorphine Approved, posted by MoQ on December 30, 2002, at 19:07:21
> > > On October 8, 2002 Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) received FDA approval for the treatment of opioid dependence.
> > >
> > > Apparently doctors will be able to starat prescribing it starting this month.
> >
> >
> >
> > Hi Peter,
> >
> > Where did you read that doctors will be able to start prescribing it this month? (And does "this month" mean December 2002 or January 2003)?
> >
> > My pdoc (who is not anti-buprenorphine) read that it was not going to be approved (or maybe he meant distributed) for another year, in one of his journals. He won't prescribe drugs with codeine for depression anyway, but he's fine with me getting them from my pain doc.
> >
> > It's hard for psychiatrists to prescribe narcotics for depression because there are so few studies supporting its success. The buprenorphine studies at Harvard/McLean Hospital have really small sample sizes. So that leaves them open for a law suit if the patient turns around and sues them for getting them "addicted". Especially with all the passion about opiate use and the lack of understanding of the concepts of habituation vs. addiction.
> >
> > Shelli
> >
>
> You know, I so wish that people would take some personal responsibility, don't you? I mean I work for a law firm and I know that a signed Release doesn't really carry all that much water anyway, but I would be willing to swear before a notary and anyone else who will listen that I promise to never sue my doctor for prescribing me something I ASKED FOR. My family physician had mentioned that doctors are now being sued by patients who asked for narcotic pain relievers and then turned around and blamed the doc for getting them "hooked." It's CRAZY!!!!O.K., I admit that I am a bit confused with regard to the Buprenorphine. Gosh, and I'm not even sure how to phrase this. Does the bup still act like an opiate acts with regard to controlling and treating the depression, depersonalization, anxiety, panic attacks, etc.? Or is it merely to stop you from using opiates? I guess I don't understand how stopping opiate use is going to help me when it is the opiate itself that has helped my symptoms and suffering/discomfort for the past five years. Please enlighten me! Thanks!
Posted by BrittPark on January 1, 2003, at 14:19:35
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
Here's a link to a disheartening article (to those of us who respond well to opioids as ADs) about OxyTrex and MorViva:
http://www.annieappleseedproject.org/ullownaltopr.html
OxyTrex and MorViva are preparations of Oxycodone and Morphine respectively, in clinical trials by a company called Pain Therapeutics.
Posted by ShelliR on January 1, 2003, at 19:53:55
In reply to Re: Buprenorphine Approved » MoQ, posted by MoQ on January 1, 2003, at 9:22:49
> O.K., I admit that I am a bit confused with regard to the Buprenorphine. Gosh, and I'm not even sure how to phrase this. Does the bup still act like an opiate acts with regard to controlling and treating the depression, depersonalization, anxiety, panic attacks, etc.? Or is it merely to stop you from using opiates? I guess I don't understand how stopping opiate use is going to help me when it is the opiate itself that has helped my symptoms and suffering/discomfort for the past five years. Please enlighten me! Thanks!
Since you don't use opiates to get high, the part about detoxing *doesn't* really apply to you. Doctors think that since buprenorphine is only a partial opiate, it is not as addictive, and would still satisfy the addict's cravings. Especially since it will be mostly used mixed with naltrexone, which would make street drugs feel very unpleasant. So an "addict" could either stay on buprenorphine or bupe plus naltrexone, or could get off all opiates, since it is easier to get first switch to bupe, then detox.
I was anxious to try buprenorphine because I was hoping that I would not become habituated on it, yet it got rid of the depression in the same manner that full opiates did. That didn't happen for me; I did have to go up and finally it became impossible for me to get over the internet, anyway. At this point my doctor doesn't really think there's much benefit in bupe over methadone for me, as I was hoping.Elizabeth was able to keep the same small dose for several years--using it as an adjunct to effexor. If it is truely coming out this month, I'm going to bring it up with my pain doctor, get his take on it.
Hope this does make some sense to you.
Shelli
Posted by rally on January 3, 2003, at 18:33:19
In reply to Re: Use of opiates in treating depression » MoQ, posted by BrittPark on December 30, 2002, at 14:48:41
it is great i have found this
i have been taking dihydrocodeine for a long time for pain but this last few yers to try and ward of on coming depression
can any one tell me which came first opiates causing the depression or the depression
Posted by BrittPark on January 3, 2003, at 19:00:03
In reply to Re: Use of opiates in treating depression » BrittPark, posted by rally on January 3, 2003, at 18:33:19
It's very hard to say whether the depression is made worse by opiates or better. My guess though is that since you've been taking opiates for a long time that they are doing little one way of the other. I think, on average, more people are made to feel better by opiates than worse. However, tolerance to opiates tends to develop rapidly for most people. You might try tapering off the opiates, wait a little bit and try again. You might find improvement then. Also if you aren't seeing a psychiatrist I suggest that you do so. An AD might be the thing you need. I believe that opiates are very effective ADs (for some people) but the currently available opioids are with perhaps a few exceptions (tramadol, buprenorphine) not effective for long term use. Tolerance builds all too rapidly.
Feel Better,
Britt
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