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Re: Why do meds constantly stop working for me? SLS

Posted by undopaminergic on September 25, 2021, at 10:50:19

In reply to Re: Why do meds constantly stop working for me? undopaminergic, posted by SLS on September 25, 2021, at 7:19:24

> > >
> > > If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
> > >
> >
> > Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.
> I didn't know that, but I very much trust your esoteric knowledge. <wink> Thank you.

I'm exceptional enough to have lost weight on clozapine. That is quite esoteric knowledge.

> > > I think the two drugs are chemically related, but I'm not sure.
> > >
> >
> > They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.
> Remember, adding a single chlorine atom turns imipramine into clomipramine (Anafranil). Sometimes, a very small change in chemical structure can make a huge difference in pharmacodynamic and clinical activity.

Of course.

> Tramadol (Ultram) is labelled an "opioid". However, it does other things pharmacologically. Tramadol is a derivative on venlafaxine (Effexor), yet possesses some, but insufficient, antidepressant activity to be given an indication by the FDA to treat MDD or BD.

The opioid effect is also an antidepressant action, although perhaps only in the short term due to tolerance.

> Tramadol is a only weak agonist at the opioid receptor compared to all other opioid analgesics. I didn't want to hit my mother's doctor with "esoteric" facts, but, like venlafaxine, tramadol is an SNRI if you discount its opioid receptor agonism. Of course, we can't, but it is conceivable to me that the inhibition of both the serotonin and norepinephrine transporters (reuptake inhibition) works synergistically with opioid agonism to produce a stronger analgesic.

Yes, or a stronger antidepressant effect.

> Duloxetine (Cymbalta), another SNRI, was touted as being particularly capable of reducing the sensation of pain (nociception) when it is used to treat depression. In fact, this property was the focus of mass-media advertisements by Johnson & Johnson.

It seems that a number of drugs not traditionally regarded as analgesics can be useful in the treatment of pain, sometimes alone and sometimes in combination with some other class of drug.

> Many people get significantly greater pain relief from tramadol than they get from ibuprofen or naproxen monotherapy.

And NSAIDs (such as ibuprofen) can produce gastrointestinal ulcers.

> Tramadol is not one of the "evil" opioids that are invaluable, but now avoided because members of the public at large use it recreationally. Excuse me. F*ck the law-breaking, hedononistic members of the public who abuse this drug illegally, and therefore make opioids out to be in alliance with the Devil. Meanwhile, people in severe, and often chronic intractable pain can't find a doctor who is willing to mitigate their suffering.

Right. It's like with the MAOIs (ie. doctors are afraid to prescribe them).

> You can't blame doctors, though. Some legally prescribed opioids are extremely problematic when it comes to physiological dependence and severe withdrawal symptoms. Not everyone experiences euphoria, gets "high", when taking an opioid. I don't have any statistics to produce, but my guess is that a sizeable percentage, likely the majority, do not receive a euphoric effect from Percocet. Those who do are screwed, though.

Euphoria, or more specifically a powerful rush, is more likely with intravenous use, and also depends on dose. And at first there are side effects like nausea and sleepiness that may outweigh any pleasant effects.

> Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.

If you mean potency per unit of weight, I think etorphine is the most powerful.





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