![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by jerrympls on December 22, 2003, at 21:36:01
Since I am going off the Nardil - Ihave had some preety intense downs. I saw my pdoc and just took a breath and told her "You know, Vicodin has always been the best anti-depressant for me and I know they use it for severe treatment-resistant depression because Dr. (name withheld) told me so (he's one of the head reasearch pdocs there. Well, she nodded and aggreed with me. See, there was nothing to help me through the holidays and the wash-out of the nardil because Nardil is contraindicated with so many things - like stimulants. Then I said - "I'm not a drug addict or anything..." and she stopped me and said "I never thought you were a drug addict nor DO I think you are." She went on to say I was right - they do use opiates and there was a good chance that the attending psychiatrists would ok this.
I saw her two days later and she gave me a thumbs up. We're going to try it for 3 weeks. She even said: "If This actually DOES work well for you, we'll revist using it longer - because you may be one of those patients who has a problem with another system besides the Serotonin/Dopamine/NE system.
I couldn't believe it. We decided on 1 tab 4x daily for 3 weeks.
Finally....finally....they listened....and we'll see what happens.....
happy Holidays!
Jerry
Posted by lepus on December 22, 2003, at 22:29:22
In reply to Doc gave me a script of Vicodin for depression...., posted by jerrympls on December 22, 2003, at 21:36:01
Yeah! How does Vicodin work for depression anyway?
Posted by Karen_kay on December 22, 2003, at 22:33:11
In reply to Re: Doc gave me a script of Vicodin for depression...., posted by lepus on December 22, 2003, at 22:29:22
Good for you! I hope it helps you!
Posted by KellyD on December 23, 2003, at 0:44:27
In reply to Doc gave me a script of Vicodin for depression...., posted by jerrympls on December 22, 2003, at 21:36:01
I see no problem with different, even "questionable" approaches to a problem as long as one is closely monitored. It sounds as if you have a good monitoring plan in place, so best to you!
Posted by mattdds on December 23, 2003, at 1:02:48
In reply to Doc gave me a script of Vicodin for depression...., posted by jerrympls on December 22, 2003, at 21:36:01
Jerry,
First of all, this is great!
But...couldn't they give you something without acetaminophen? Vicodin is hydrocodone with acetaminophen (APAP). Might be a bit hard on the liver if you're thinking long-term. You'll have to weigh this, and monitor your APAP intake.
Problem is, I don't think they make a tablet with only hydrocodone. They only make oxycodone preparations, as I recall.
Did your depression ever respond to Percocet or any of the other oxycodone containing combinations?
I don't mean to meddle with a good thing, but I would be concerned about taking acetaminophen daily if you can avoid it. It's like taking Tylenol PM for sleep problems only - why not just take the diphenhydramine (unless you have a headache too)?
Anyway, hope it works for you!
Best,
Matt
Posted by Viridis on December 24, 2003, at 2:11:26
In reply to Re: Doc gave me a script of Vicodin for depression.... » jerrympls, posted by mattdds on December 23, 2003, at 1:02:48
You can also get Vicoprofen -- hydrocodone with ibuprofen. Ibuprofen has liver issues too, but (from what I understand; I'm no expert) these are much less severe than for acetaminophen. I happen to be sensitive to acetaminophen, so have requested Vicoprofen for dental problems etc. Many doctors/dentists don't think of it but are quite willing to prescribe it if you mention it. I don't think that hydrocodone alone is available, in the U.S. at least.
Posted by mattdds on December 24, 2003, at 17:05:49
In reply to Re: Doc gave me a script of Vicodin for depression » mattdds, posted by Viridis on December 24, 2003, at 2:11:26
This is a good point. Actually we give Vicoprofen routinely when doing oral surgery, when I'm on rotation. Many of my faculty believe it is superior to the acetaminophen combo, at least for pain. I also think the reps are marketing it pretty heavily at my dental school because everyone has Vicoprofen pens.
The issue with ibuprofen not liver problems (it's renally metabolized), but GI ulceration. This mainly happens in high doses, like those used for arthritis.
Vicoprofen is 7.5 mg of hydrocodone (pretty big dose) and only 200 mg of ibuprofen (very small dose). If you were to take 400-600 mg ibuprofen every day (2-3 doses of Vicoprofen), I would imagine you would have no problems with the GI ulceration.
Matt
Posted by mattdds on December 24, 2003, at 17:08:36
In reply to Re: Doc gave me a script of Vicodin for depression » mattdds, posted by Viridis on December 24, 2003, at 2:11:26
Also, they recently discovered that chronic low-moderate doses of ibuprofen had a preventive effect against Alzheimer's disease. Possibly another reason to consider going with Vicoprofen over Vicodin.
Posted by Viridis on December 24, 2003, at 21:39:57
In reply to Re: Vicoprofen » Viridis, posted by mattdds on December 24, 2003, at 17:05:49
Thanks for clarifying that. I thought there was some liver-related issue with ibuprofen, but I'm probably confusing it with the potential GI problems. I actually know someone (a nurse, in fact) who experienced massive blood loss due to ulcers induced by ibuprofen. However, she was taking pretty huge doses for chronic, severe pain (now managed in part with morphine -- ironically, she had wanted to avoid opiates).
Interestingly, an endodontist who I've seen a couple of times for a particular problem tooth (long story; I finally wound up having an apioectomy) warned me that the amount of ibuprofen in Vicoprofen is too low for adequate anti-inflammatory effects, and insisted that I supplement the Vicoprofen with an additional 200 mg of regular ibuprofen. This worked very well for pain management.
But for psychiatric issues, the low level of ibuprofen in Vicoprofen is probably a good thing.
BTW, I find hydrocodone a great mood-lifter. I've never taken more than the prescribed amount or gotten high from it, but it seems to hit some sort of "reset" button in my brain that improves my mood for two or three days after a single dose. I'm going to approach my pdoc about getting a small prescription for occasional use, but although he's quite progressive, somehow I doubt he'll go for it. It's worth a try, though, and at least he knows me well enough that he isn't likely to consider this drug-seeking behavior.
It's a shame that opioids are such taboo meds in psychiatry, because they really do seem to work wonders for some people.
Posted by mattdds on December 25, 2003, at 2:50:00
In reply to Re: Vicoprofen » mattdds, posted by Viridis on December 24, 2003, at 21:39:57
>>>...in Vicoprofen is too low for adequate anti-inflammatory effects, and insisted that I supplement the Vicoprofen with an additional 200 mg of regular ibuprofen. This worked very well for pain management.
Wow, crazy. At my dental school, we did the exact same thing during oral surgery rotation! We (well, we and an observing, licenced oral surgeon) would prescribe Vicoprofen, but instruct the patient to take an additional tablet of Advil or Motrin. 200 mg is indeed way too low a dose to have any anti-inflammatory effect. In my opinion 200 mg probably doesn't even have an *analgesic* effect. I take OTC ibuprofen all the time and need at least 600 mg for tension headaches. Some people theorize that hydrocodone and ibuprofen act synergistically rather than additively, but I personally doubt that.
>>>But for psychiatric issues, the low level of ibuprofen in Vicoprofen is probably a good thing.
Exactly my thinking. Probably the next best thing to pure hydrocodone that's on the market (for psychiatric purposes). Sadly, I don't think we'll ever see a pure hydrocodone tablet made though.
>>>BTW, I find hydrocodone a great mood-lifter.
Many people do, and it's too bad that "mood-lifter" has such a negative connotation these days. I mean, shouldn't that be the goal of depression treatment? A lifting of the mood?
I've noticed that there are some "oxy" people, some "hydro" people. For some, hydrocodone really works, while for others oxycodone does. Oxycodone seems to have more euphoria / abuse issues associated with it, than does hydrocodone. Everyone is different. I personally don't really get anything but fuzzed thinking, constipation, and depression from the opioids. Weird.
I am sympathetic, however, because a drug that helps me (Klonopin) is somewhat taboo to some. New York State even requires a triplicate prescription and will not allow refills for benzodiazepines. Some psychiatrists are now prescribing meprobamate (much less safe, very low therapeutic index) instead now, simply because it's less of a hassle.
>>>It's a shame that opioids are such taboo meds in psychiatry, because they really do seem to work wonders for some people.
I totally agree. It's interesting that for centuries, opioids were the mainstay for "melancholia". Now that big pharm has stolen the show, psych doctors seemed to have bought into the whole "addiction" fear 100%.
Even in dentistry, where there is an obvious etiology (e.g. traumatic tooth extraction), and an obvious need for pain relief, some conservative dentists will not write for anything but ibuprofen. They always cite fear of getting the patient "addicted" as the reason.
To me opioids seem great, you solve two problems at once: the obvious physical pain, and also the psychological pain of getting a tooth pulled or worked on. I think patients deserve that. Dentistry is traumatic, both physically and psychologically!
So when I graduate in around 4 months (and actually have a say in my prescription writing), I know what my patients will be getting for moderate to severe pain relief (assuming, of course, that it's indicated).
I think your idea of requesting a small supply for mood breaks is certainly worth a shot. Some doctors seem to be revisiting the idea of using opioids as a treatment for depression.
Happy holidays!
Matt
Posted by jerrympls on January 4, 2004, at 22:01:54
In reply to Re: Vicoprofen, posted by mattdds on December 25, 2003, at 2:50:00
Thanks everyone for the info regarding Vicoprofen. I see my pdoc this week and I'll disuss this with her. she too was a little concerned about the acetametophen (sp?) - which I can understand. Problem with ibuprofen for me is stomach irritation - however, if it has less problems with the liver - then it may be a better choice.
Regarding oxycontin and hydrocodone - I have an almost completely different response to each - however, they both are excellent antidepressants for me and also have somewhat of a "reset button" action on my depressive episodes. I almost could take 2 tabs one day and have an antidepressant effect for a couple days.
So far, the Vicodin has been the BEST antidepressant - I don't get high or euphoric - just feel like I "should" - "normal" NOT better than good - make sense?
Anyway, my pdoc said if this has a substantial positive effect on my mood that they would work it out to possibly keep me on it and use it as an antidepressant. Apparently they've used this treatment before with TRD patients when all else fails.
And best of all....music sounds and feels good in my soul again....after 12 years in darkness....
I'll keep you all updated!
Jerry :-)
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.