Posted by Elizabeth on March 22, 2002, at 21:52:36
In reply to opiate/opioid therapy, posted by A0102 on March 21, 2002, at 7:59:54
Hi Adam.
I've been taking buprenorphine for more than a year. Regular ADs (MAOIs, TCAs, Effexor) have helped me, but only partially. I'm doing a lot better on the combination. I've known a few doctors who treated other patients with opioids (even full agonists like OxyContin and MSIR) and observed no tolerance or abuse. One way that doctors can reassure themselves is to have you get urine screens every so often to make sure that you're taking the medication as directed. Starting the medication in an inpatient setting might also help. My pdoc had me sign an informed consent; I'm not sure what that's worth, but it seems to be standard (for people being treated for chronic pain with opioids). Anyway, if there's anything in particular that you'd like to know, I'm happy to answer your questions.
I noticed a couple of things from your post that I wanted to ask you about.
The hypomanic stuff you get when you start on SSRIs is very suggestive, as you recognized. You didn't mention whether you've ever tried taking an anticonvulsant (or lithium) and then adding an AD. I think this can make a lot of difference in bipolar depression (even "bipolar III").
Also, can you say more about your depression? Like, what kind of symptoms do you have and how did the hydrocodone help with them? Have you been diagnosed with anything else besides depression?
Have you ever taken a benzodiazepine? (In particular, Xanax.) What about Parnate? ECT? Can you list any augmentation strategies you've tried (thyroid hormones, stimulants, lithium, antipsychotics, etc.)?
The stuff that hydrocodone did for you sounds pretty much like the typical experience of opioid-responsive depressed people. Tolerance is the biggest concern, I think: I'm not sure how common it is, but I think that it's probably frequent (although not universal). Taking buprenorphine rather than a full agonist might reduce the risk of tolerance (buprenorphine also has much milder withdrawal symptoms than the full-agonist opioids).
Opioids won't help with excess stomach acid; I'd suggest Maalox for that. They will eliminate any diarrhea you may be having, though!
> My concern with this is that since it does seem to be such a miracle med for me, is that just begging for an addiction?
You know yourself best. Do you think you're the type of person who'd become addicted, or be tempted to abuse it? (impulsive, thrill-seeking, etc.) It's a hard question, and you can't know for sure; you just have to use your judgment.
-elizabeth
poster:Elizabeth
thread:99196
URL: http://www.dr-bob.org/babble/20020322/msgs/99561.html