Posted by psychobot5000 on June 20, 2012, at 17:16:37
In reply to Re: going off meds - finding doc for opiods or stims?, posted by novelagent on June 17, 2012, at 22:42:48
> Well, considering long-term use of opiates doesn't work, even for pain patients... I find that stupid. Not to judge or anything, I just think you're being an idiot. (No offense). The klonopin and the stimulants, those are fine, but do yourself a favor, and get out of obsessing about opiates while you still can afford to not care about them.
> It will only lead to addiction, no matter how strong your will power is, and it will have nothing to do with with whether you "abuse" them or take them as prescribed. Either way, you'll still wind up switching to heroin when you can't afford to buy extra pills off the street.
For what it's worth, I find most of the statements here to be either gross exaggerations or....not accurate in all circumstances.
So far as I am aware, most doctors and researchers believe that opioids are not addictive if one does not escalate the dose to chase the initial high (i.e. 'chase the dragon').
Addiction is not a foregone conclusion, and while clearly it can ruin lives, it seems to this patient, having been on several classes of addictive medication, that much of it probably depends on your personal biochemistry, and that well-meaning folks often make overbroad statements about the dangers of dependency/addiction.
All that said, I do not particularly recommend looking for opioids as a treatment for depression or bipolar. it's incredibly unlikely one will find a doctor willing to engage in such treatment, and, if successful, any positive effects may disappear in time. That said, there appears to be substantial anecdotal evidence that buprenorphine it may be effective for an extended period, and it is also less addictive than other opioids--which is not to say that there is no risk at all.
For what it's worth, I was trialled on buprenorephine, and did not find it a pleasant medication. Others clearly have different experiences, however.
Stimulants probably have a better track record of providing sustained benefit for mood, as an adjunct to normal antidepressants. The risks of tolerance and addiction may also be less than with opiates.
At the risk of repeating myself, it is not 'stupid' to look into opioids, but, with the possible exception of buprenorphine, I think most patients are probably better off looking elsewhere: low doses of that one atypical antipsychotic you haven't tried, ketamine and other NMDA agents, TMS, ECT, stimulants.