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Re: Opiates for depression? Cecilia

Posted by Elizabeth on May 13, 2001, at 13:44:26

In reply to Re: Opiates for depression?, posted by Cecilia on May 12, 2001, at 23:20:17

> I`m quite certain my HMO would never approve of opiates for depression-there`s no way I would even ask.

HMOs vary widely. Mine is a nonprofit that's basically owned by a university (the preferred hospital is the university-affiliated one, of course). The prescription plan is completely separate from the other parts. They recently adopted a formulary, where some drugs are "preferred" and have lower copays, but all prescription drugs are covered at least to some extent. So I can get Buprenex (or the generic that Abbott recently came out with) at any pharmacy that takes my insurance, as long as I have a script.

Most doctors don't even know what buprenorphine is (though some have a negative knee-jerk reaction based on the "-orphine" ending!). I think if they read up on it they'd realise it lacks a lot of the disadvantages associated with other opiates, and they'd be very willing to prescribe it. (The FDA considers it to have less abuse potential than benzos, Ambien, Provigil, and the like.) It would also help if the drug companies would come out with a metred-dose inhaler; right now the only way to administer it effectively requires the use of syringes, which doctors hate to prescribe.

> But I`m curious- I received morphine and Percocet following surgery a few years ago and they certainly didn`t make me high or less depressed or give me any desire to take more once the post-op pain was over.

You and 70% of the population. (Were you depressed at the time?)

> Do the people who respond to opiates for depression find they get an anti-depressant effect when these are taken for pain?

Yes. I was mildly depressed (residually -- I have double depression) when I received Vicodin ES (hydrocodone 7.5mg/APAP 500mg) after having my wisdom teeth out. As soon as I felt it, the not-quite-rightness that I've felt all my life vanished, and my mood returned to normal. A lot of people discover opioids this way. Those who move on to self-medicating with heroin are at high risk for addiction, especially those who take it intravenously (who also risk a number of medical complications such as infections and abscesses). Those who are able to find a doctor willing to prescribe opioids and monitor their use have little risk as long as they use the medication as prescribed.

Codeine in therapeutic doses for pain doesn't seem to have this effect, although it does have the same side effects than stronger drugs like hydrocodone or morphine. I think higher doses of codeine would probably work, but with worse side effects than similarly effective doses of morphine, oxycodone, etc. Buprenorphine works in extremely low doses (i.e., it is very potent, comparable to fentanyl) and is qualitatively distinct from other opioids, although I believe that opioid-experienced people (and rodents) can generally identify it as an opioid.





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