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sustained effects loosmrbls

Posted by Elizabeth on May 18, 2001, at 20:26:42

In reply to Re: Nichole, I'm with you!!, posted by loosmrbls on May 18, 2001, at 8:11:12

> Indeed, opiate receptors may play a role -- and some people speculate that those who cut themselves do so to release endogenous endorphins and other chemicals that bind to opiate receptors and reduce pain.

Yes. Someone I know who is a "cutter" says that naltrexone has helped her tremendously with that problem. In contrast, people with uncomplicated depression often seem to find naltrexone either neutral or dysphoric.

> However, I have one question. Has anyone had good, LONG-TERM success with these drugs releiving depression and bringing one into "euthymia" and functionality?

I know someone who took Ultram daily for several months and did not increase the dose. My pdoc has used morphine and buprenorphine as ADs with no dosage increase required. I've been taking buprenorphine for 2 years (though not continuously) and for as long as about six months at a stretch. And get a load of this (this is an excerpt from a letter to the editor published in the American Journal of Psychiatry):

"This report describes three patients with chronic and refractory major depression who were treated with the -opiate agonists oxycodone or oxymorphone. All three patients experienced a sustained moderate to marked antidepressant effect from the opiates. The patients described a reduction in psychic pain and distress, much as they would describe the analgesic effects of opiates in treating nocioceptive pain.

"...None of the patients abused the opiates, developed tolerance, or started using illicit substances.

"We used oxycodone in three additional patients without histories of opiate abuse. In two of these three patients, oxycodone produced a similar sustained antidepressant effect. ... Opiates should be considered a reasonable option in carefully selected patients who are desperately ill with major depression that is refractory to standard therapies."

(Am J Psychiatry 156:2017, December 1999. Treatment Augmentation With Opiates in Severe and Refractory Major Depression. Andrew L. Stoll, MD, and Stephanie Rueter, BA.)

Stoll is a very well-respected researcher at HMS. (Yes, he's also the fish oil guy.)

> I can only see one road with these drugs: (1) Sedation and at least a mild impairment in daily functioning (2) Tolerance (if not addiction) (3) a large potential for overdose.

(1) I find them activating, not sedating. (2) As noted above, a lot of the case reports I've heard/read about suggest that tolerance doesn't always occur and may be the exception rather than the rule. (3) The overdose potential is the biggest problem, IMO. This is an advantage of buprenorphine: it is virtually impossible to kill yourself by ODing on it (because it has a ceiling effect).

> My experience has been that these drugs mask, not relieve, depression.

Can you explain what you feel the difference is? To me it's mostly a matter of time course.





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