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relieve vs. mask loosmrbls

Posted by Elizabeth on May 21, 2001, at 20:21:18

In reply to Re: Ultram dose, posted by loosmrbls on May 21, 2001, at 8:42:01

> One thing I want to describe is what I mean by "relieve" and "mask."
>
> By "relieve" I did kind of mean cure, because antidepressant drugs are/were designed to correct chemical imbalances in the brain (monoamines -- dopamine/serotonin/norepinephrine) that are believed to play a primary role in the symptoms (if not cause) of depression.

The belief you mention resulted from the fact that monoaminergic drugs (tricyclics and MAOIs) are antidepressants. The AD effects of tricyclics and MAOIs were discovered by accident; these drugs certainly weren't designed to treat depression. Their pharmacological actions were discovered later; this resulted in a search for other drugs with similar or related pharmacological actions. The newer ADs were selected for study as potential ADs based on their pharmacological effects, which were similar to those of known antidepressants.

> That would be a cure. Many people eventually come off of AD's without a recurrence of symptoms and never have another problem (I have a friend like that who took Zoloft). But obviously he does not represent the users of this forum.

I've known some people like that. In general they had a single episode of mild or moderate depression.

> By "mask" I mean induce a sense of euphoria -- much like alcohol does -- that does not address the problem but hides it. Just like opiates do not "cure" the cause of pain (like a broken bone) but "mask" the pain.

I see. I don't think this is applicable, in my case anyway. I don't feel euphoric or intoxicated on opioids at any dose I have taken. (I don't take large amounts by any standard.) It is true that some people try to "mask" depression with sedatives such as alcohol or benzodiazepines

> So in that sense, AD's "cure" depression (in theory) by working on the primary cause, while opiates "mask" it by relieving the pain.

Monoaminergic ADs relieve depression for as long as you're taking them. About 50% of people who experience a major depressive episode will not suffer any recurrences, so the fact that some people do not relapse after going off ADs doesn't mean that they were truly "cured" by the ADs (since they might not have relapsed anyway).

> I, like many people here, have suffered from a mood disorder for years (3), have been on multiple antidepressants with no success (often worsening), multiple mood stabilizers, and nothing has worked thus far.

I think that as long as we keep looking for new ADs that are similar to the ones we already have, we will never find one that is truly novel and that will work for those who have found no relief elsewhere.

> I have cut myself only once in my life during a very bad depressive episode, have never felt the need to since.

Out of curiosity -- did you experience relief the one time you did cut yourself? Can you say what led you to do it?

> Someone mentioned naltrexone helping them -- I find that fascinating because naltrexone actually blocks opiate receptors, in effect "shutting down" the opiate pathways. This would actually suggest opiate excess.

It could be that when they take naltrexone, these people no longer experience relief when they cut, so they stop doing it. Another possibility is that naltrexone prevents dissociation, which may be associated with or lead to cutting. I would be curious to hear from anyone who has used naltrexone as a treatment for self-injurious behaviour and might be able to shed some light on how it works.

> And I know there are multiple subtypes of opiate receptors (at least four) and people respond differently to these drugs.

There are three subtypes -- mu, kappa, and delta. ("Sigma" receptors were at one point thought to be opioid receptors; they turned out to be something else.)

> OK, sorry for the long post. After three years of dealing with depression, I am coming to believe that "depression" is like a "fever", a common symptom (or syndrome) that can occur from any dysfunction of a chemical pathway within the brain -- and certainly opiate pathways can be one of them.

I wouldn't go that far, but I'm sure there are multiple possible causes.

-elizabeth


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poster:Elizabeth thread:63214
URL: http://www.dr-bob.org/babble/20010515/msgs/63865.html