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buprenorphine for depression » SLS

Posted by pseudoname on March 4, 2006, at 16:50:56

In reply to Re: Everything works for somebody..., posted by SLS on March 4, 2006, at 14:33:35

> If you wouldn't mind answering a few questions...

I never tire of talking about buprenorphine. As you can see from the length of this post! ;-)

[For lurkers: buprenorphine (Subutex, Suboxone) is a mild synthetic opioid usually prescribed to opioid addicts in recovery programs. I'm not an addict.]

> How would you describe your depression?

Unipolar with obsessive traits. I'm 40 and I've had it since at least 17. Sometimes (like yesterday, when I went without the bupe because I felt so good in the morning) all of a sudden it feels like sandbags are attached all over my body, and I have to lie down with my eyes open; never actually sleep. My body goes numb-like. I call that my “catatonic” depression.

Even if not catatonic, I often can take no action whatsoever, asking, “What's the effing point?” “Why would I brush my teeth?” etc.

I can also be more active yet overwhelmingly convinced that I'm worthless & loathsome... you know the drill. Also it can be impossible to make routine decisions. Also, pre-bupe, I often feared people seeing me, so I'd stay in my house for a week at a time.

I often go without eating. I sometimes have trouble falling sleep, but even maximally depressed, I don't sleep more than 8 hours.

Even when I'm not particularly depressed, there are lots of simple, routine tasks I find bizarrely impossible. My pdoc thinks it's an OCD-related fear of criticism.

I don't know if that description tells you what you want to know. I can't understand the find official labels.

> Does the buprenorphine alleviate all of the symptoms entirely?

No. Great question! Buprenorphine does not make me chipper or gung-ho or energetic. It doesn't seem to increase my desire for ... I dunno, achievement. It doesn't give me any confidence, it just takes away the intensity of failures. It doesn't make me read or think intensively like Adderall does.

Buprenorphine switches on a mild, positive feeling, and the “What's the effing point?” question goes away.

On bupe, I have increased humane thoughts: I *care* about people I know without getting emotionally wrought. It's easier to feel sad! The sadness is so different from depression; I feel it & keep going. Hugs feel *good* on buprenorphine. My extremely low social status & decades of personal failure seem only unfortunate, not horrific.

It doesn't make any direct difference with my bizarrely impossible routine tasks. BUT since starting the bupe, I have had a few remarkably effective personal insights that I keep applying to situations and they keep working. So these bizarrely impossible tasks are gradually falling one by one. Previous to bupe, I never had insights or cognitive “tricks” that continued working more than a few times.

I'm much less afraid of being seen. I can “talk” myself out of the fear, if it comes up.

Most of these gains don't seem to persist much when I'm off the buprenorphine.

> How many times a day do you have to take it and at what dosage?

After titrating up for a few weeks to an effective dose, I took 1 mg of sublingual Subutex tablets 3 times a day (6 AM, noon, 5 PM) in Dec and Jan. Then my GP took me off the bupe for 12 days due to an unrelated problem. I'm now back on it, finding a much lower dose is effective, about 0.5 mg at 7 AM and 0.2 - 0.5 in the afternoon if needed. Sometimes a *little* more.

It has a pronounced window of effect. On, off. But it takes an hour to kick in, so I never feel a craving for it like I have had for coffee.

I have more specific advice for starting, but begin with a very low dose, 0.1 or 0.2 mg/day.

> What other medications do you take?


> I think I'll bring up buprenorphine with my doctor at some point. ... I don't know if he'll go along with it.

I showed my pdoc the literature. She prescribed Subutex saying, “I figure you probably won't sue me if you get addicted.”

I previously got turned down by 3 pdocs for bupe. They incorrectly thought it was against the law to prescribe it off-label, then outright refused. My current pdoc thought she had to have the SAMHSA waiver to prescribe it, but we got that cleared up with the pharmacist.

I posted on buprenorphine laws here (and following):




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