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Re: Codeine for Depression Treatment » paulk

Posted by Elizabeth on May 29, 2001, at 19:37:36

In reply to Re: Codeine for Depression Treatment, posted by paulk on May 29, 2001, at 13:11:30

> Perhaps I did not make it clear – it is the use of an opiate COMBINED with an opiate blocker – which blocks the euphoric effects – that has been used as an antidepressant. (I doubt with overwhelming success or there would have been some write-ups in the press.)

You mean the popular press, right? There have been reports in peer-reviewed scholarly journals (it's hard to do large-scale clinical trials because nobody wants to provide the funding). Some of these published papers are available on the web. Here are a couple of links:

There's at least one other clinical report that I know of, a case series which was reported in a letter to the editor of the American Journal of Psychiatry. I will post that report in a separate post in this thread.

> I am not encouraging the use of opiates – although I would rank them as a lesser evil than alcohol.

Alcohol is an organic solvent -- I consider it to be more of a toxin than a drug! It's very "dirty." It's more dangerous than just about any medication or recreational drug I can think of that is used today, except maybe inhalants (industrial solvents in paint thinner and such that some people think are a good high) and some antineoplastics.

> Most people, if given a free supply to opiates would chose not to use them – I wouldn’t. I just don’t see why alcohol is legal – even though it is clearly a very dangerous drug – while we criminalize other dangerous drugs.

This baffles me also. For some reason, the government at the time was able to admit that alcohol prohibition was a mistake, but they can't seem to face up to the failure of current drug prohibition laws. I also don't understand how the government can rationalise today's prohibition through federal and state laws and regulatory agencies, when an amendment to the Constitution was required to criminalise alcohol.

On a related note, look at how effective anti-tobacco education has been in getting people to stop smoking. The availability of nicotine substitution and bupropion has helped make it easier to quit, but I think it's the publicity about the dangers of tobacco smoking that has made smoking so unpopular, even though you can buy cigarettes at any convenience store. I think that abuse of currently illegal drugs would be reduced to nearly zero if the government spent its money and effort on education instead of prosecution and imprisonment.

> It is my contention that IF opiates combined with an opiate blocker turned out to be an excellent antidepressant it wouldn’t be prescribed because of the social stigma attached to opiates.

Well, I still don't understand what you mean by "opiates combined with an opiate blocker," but there is a mixed partial agonist/antagonist -- buprenorphine -- that is an effective antidepressant (I know because I take it) and that doesn't get you high. (The paper at discusses this drug and its antidepressant properties in depth.) As you surmise, most pdocs are loath to prescribe buprenorphine, not on any scientific or medical basis but because of social stigma. Once they hear that its name ends in "-orphine," they no longer care to hear about its pharmacological properties.

Another drug with a similar pharmacological profile -- dezocine, brand name Dalgan -- used to be available, but it was recently taken off the market because it hadn't been profitable. My guess is that partial mu opioid receptor agonists like buprenorphine and dezocine are not very good pain killers, but the only indication that they're labelled for is pain. (Buprenorphine is currently being studied as an addiction treatment.)

> Again – just to be sure this is not miss understood – I am not recommending anyone use opiates, alcohol or any other dangerous drug – I don’t myself and haven’t seen anything that suggests that they are a long term therapy to depression.

There's no such thing as a completely safe drug. Opioids are safe enough to be used when the need is great enough; for example, they are regularly used for pain (including chronic pain) and as maintenance therapy for addictions. People can function very well while using opioids on a daily basis under a doctor's supervision. I think that if tricyclics -- which can cause potentially lethal cardiac arrhythmias and are quite toxic in overdose -- are safe enough to be used as antidepressants, then opioids are too.





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