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Re: Codeine for Depression Treatment » paulk

Posted by Elizabeth on May 29, 2001, at 23:14:12

In reply to Re: Codeine for Depression Treatment » Elizabeth, posted by paulk on May 29, 2001, at 21:16:15

> Very interesting - first time I have seen anything in print on this.

That's because you don't read the professional journals. :) It's not sensationalistic enough to make the popular news media, I'm afraid. It's hardly news: opium and its derivatives have been in use as psychotropic medicines for thousands of years.

> I would have to see a double blind study with a much higher ‘N’ before I would get excited.

Like I said -- no funding. The patents on existing opioids (including buprenorphine) have expired, so the drug companies have no motivation to fund such studies. The lack of acceptance of the idea on the part of the medical community makes it unlikely that new drugs will be developed for this purpose.

I mentioned that buprenorphine is being studied for treatment of heroin addiction. The problem is that the formulation being studied -- a sublingual tablet (buprenorphine is currently available in the U.S. only as an injectible solution) -- is not very effective. I would like to see a metred-dose nasal inhaler (like Stadol NS), but for some reason, nobody seems to be interested in trying that. (I take buprenorphine intranasally, and it works -- not as fast as intramuscular injection, but in about the same dose range.)

But anyway, I got "excited" as soon as I found that it worked for me. For a person with TRD, n=1 is enough if they happen to be the 1 in question.

> About my only experience with opiates were Demerol for kidney stones and surgery – I skipped the pain med as much as possible because it would keep me from peeing. – I also used codeine cough syrup for a cold a few times – neither seemed ‘stimulating’ to me?

Codeine is a very weak opiate (I don't think I ever took it while depressed, but I don't recall any interesting effects from it the couple times I had it, either). Demerol is atypical in that it's relatively excitatory compared with morphine.

> About the only other information related to narcotics I know about is that Cocaine acts as a norepinephrine reuptake inhibitor (suppose the media would equate cocaine with the SNRIs).

Cocaine is a nonselective monoamine reuptake inhibitor (dopamine, norepinephrine, and serotonin). Medically, cocaine is used only as a local anaesthetic -- very different from systemic use as a psychostimulant.

> It was described to me as a combination of an opiate (which one I don't know) and I think it Revia (Naltrexone).

There's some research suggesting that ultra-low doses of naltrexone or naloxone can prevent or slow the development of tolerance to morphine. But that's not something that's in clinical use. (The appropriate dose of naltrexone to use in humans hasn't even been established.)

> It was some time ago – I tried using Naltrexone to counter the old sex side effect of Effexor – it didn’t work – I told my pys doc about this attempt and he told me of treating some treatment resistant patient with such a mixture.

Yes, some people have said they've successfully augmented ADs with naltrexone. That surprises me, since it's supposed to be a not-very-pleasant drug.

> One last thought on the social stigmas some drugs have – Both Cocaine and Opiates were associated with minorities (blacks and Chinese) when these drugs became disreputable.

Of course -- same with marijuana. Most drug prohibition grew out of racism.





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