Posted by Chairman_MAO on October 19, 2011, at 14:09:38
In reply to Re: opiates and major depression » Chairman_MAO, posted by CaptainAmerica1967 on October 19, 2011, at 8:29:28
> Yes, I cannot deny that the opioid Mu receptor made me feel a little better but no more than any of the 100's of medications I've taken over the past 28 years of my life.
That is highly individualized, and not everyone feels that way (I am not speaking for myself here).
> However, morphine did not make me feel like the buprenorphine. Pharmaceutical companies are working on several kappa antagonists and even addiction specialist, the head of NAABT, Richard Gracer, MD said depressed patients feel better on buprenorphine because of the kappa receptor antongism and believes that individuals /c depression have an impaired or overactive kappa system.
Kappa antagonism is promising, but bootstrapping from psychopharmacology to some sort of pathophysiology is absurd. You can "believe" whatever about whatever you want in this field with virtually no evidence.
> Difference in treating refractory depression (TRD) vs opiate addiction is the dose SL tablets; TRD .5 mg - 4 mg QD vs addiction TX up to 20 mg of buprenorphine day.
That's funny, I got on it for depression and got the best effect at 4mg qid (sublingually of course), which is where, in most people, it seems to have the greatest analgesic effect. Taking it four times daily is different than taking it once or twice daily.
> Gracer states that taking buprenorphine for depression isn't a weakness and is no different than patients who must take an antidepressant for a lifetime and shouldn't feel ashamed about that.
I don't think that anyone should feel ashamed for using any drug for any reason unless there are negative consequences--especially if it has _positive_ results.
> I always told my depressed patients that it's no different that some of my diabetic patients that must remain on insulin for a lifetime.
That's a quaint narrative, but it belies reality. You know it doesn't work like insulin. I am really tired of http://en.wikipedia.org/wiki/Pharmacological_Calvinism
You could make it _metaphorically_ like taking insulin, but it is not like taking insulin.
> I have developed osteoarthritis in the left knee from being an extreme athlete in trying to control my depression via endorphins, enkephalins release from extreme workouts all of these years and buprenorphine has a similar effect of calming my brain down after a hard workout
You mean calming your mind down?
>and buprenorphine is indicated for osteoarthritis, but only the liquid injectable form which I refuse to take as injecting buprenorphine can really make one addictted and have severe withdrawal so I pay for the sublingual tablets off label 2 mg BID or $100 for 60 tablets,
Injection vs. sublingual administration is just a matter of convenience. The SL bioavailability is so poor, that is why the doses of the SL tablets is so high. This has nothing to do with "addiction".
> a months supply; Butrans patch by Purdue Pharma recently came out with their buprenorphine patch and is indicated for osteoarthritis pain but Medicare is denying it currently.
That's a shame.
> The original buprenorphine study on TRD by Bodkin et al, used the liquid form but either used the buprenorphine liquid intranasally (60% bioavailability) or liquid sublingually (50% bioavailability) which is better than the sublingual tablets (40% bioavailabity) but the cost of the liquid is about 3x as much as the tablets and am not sure of the cost of the Butrans patch yet (50% bioavailabity).
The sublingual bioavailability varies, but for the tablets it is about 30%.
> I've had 70 ECT's when I was 18y/o-19y/o right /p high school graduation in '85 over a yr. period, tried over 100 medications since I was 16y/o in 1983, studied medicine as a PA to try to research TRD more on my own and have for years even prior to studying medicine in the early '90s and the MAOI type A antidepressants seem to work the best. Parnate is the best in my personal opinion at least for me with the comorbid depression with anxiety even though I took Nardil (has GABA inhibitor but mroe toxic to body) for 12yrs but Parnate has less side effects and boosts libdo, but I personally need clonazepam for the anxiety, for seizure prevention of high dose antidepressants in which I'm taking 100 mg of Parnate
Unless you are epileptic, you're unlikely to get a seizure from 100mg/day of tranylcypromine. Plus, you don't use a benzo as a primary anticonvulsant--certainly not in seizure-prone people--because they lose effectiveness over time and as tolerance and dependence sets in, they become less useful in status epilepticus.
That is because MAOIs are the best antidepressants --at least among drugs labelled as such. Good dose for "high-dose" tranylcypromine is 1.5mg/kg/day or a max of 200mg/day. The major concern AFAIK is thrombocytopenia if you keep going higher plus inhibition of other enzymes. I think knocking out MAO-A and MAO-B produces a more robust effect; knocking out MAO-B has a cascade of effects from letting more trace amines (namely PEA) remain around.
> (high dose of trazodone, 1000 mg caused the seizure in 1986 and could have sued my psychiatrist but it wasn't going to bring back my Mother),
1000mg? Insane. I'm sorry to hear that.
> and lastly need clonazepam for my REM sleep disorder; muscles aren't paralyzed during REM sleep, stage 5 as I sleepwalk, thrash, kick, punch-last girlfriend got a black eye-has made me hesitant towards longterm dating, talk all while sleeping and go directly into REM sleep instead of the 90 minutes it normally takes to go through the typical sleep phases-shoretned REM latency which is really more related to TRD. I just started taking Xyrem (known as GHB or sodium oxybate) for my REM sleep disorder which helps tremendously in getting at least 3-4 hours of sleep without before waking up as I used to sleep for one to two hours and wake up from thrashing, sleepwalking or talking in my sleep and Xyrem also helps /c the depression and anxiety.
GHB is good stuff. Really non-toxic, too.
> My depression is definitely an overactive brain as sleep deprivation works wonders for me (as do cold showers/baths) and calms my brain down (reduces glucose levels in the brain? Increases monoamines? Increases libido-increased dopamine?) but as soon as I get any amount of sleep, the depression/anxiety/hot flashes/difficulty concentrating returns.
What is "overactive brain"?
> Neurolgist Helen Mayberg of Emory Univeristy has shown that everyone with depression has certain parts of the brain that use too much glucose consumption-hyperactivity, areas around Broadmann's area 25 or the subgenual cingulate which controls serotonin transporters and controls the hypothalamus that in turn controls various mood areas of the brain like the amygdala. Additional studies with deep brain stimulation have shown that stimulating the white matter surrounding area 25 is just as effective in treating TRD and all of these areas are hyperactive to meaning too much glucose consumption is being used as shown on the PET Scan..
Could you provide me with citations of these papers, please? I am interested.