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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 115 to 139 of 164. Go back in thread:
Posted by Elizabeth on January 24, 2002, at 12:52:18
In reply to opioids, posted by christophrejmc on January 23, 2002, at 20:41:22
BTW, buprenorphine doesn't have to be injected. It's effective when taken intranasally and sublingually (although the dose, at least in the latter case, is much higher than the injected dose).
-e
Posted by christophrejmc on January 25, 2002, at 1:01:58
In reply to Re: opioids » christophrejmc, posted by Elizabeth on January 24, 2002, at 12:47:08
> > Is there any reason why buprenorphine would be a better choice for depression than the other opiates?
>
> There are several, which are discussed in the Bodkin et al. article. The following factors make buprenorphine a better choice than a full agonist.
>
> - less toxicity in overdose
> - little or no potential for abuse or addiction
> - much milder withdrawal symptoms
> - lacks Ultram's potential for precipitating seizures
> - action lasts longer than most opioidsThanks, although the last point is probably the only one that matters to me at this point.
> > Strangely, it's easier for me to get schedule IIs than the lesser controlled opiates (legally, btw).
>
> Buprenorphine in particular, or less controlled opioids in general (e.g., Stadol, Talwin, Nubain, etc.)? Doctors often shy away from buprenorphine because it's only available (in the U.S.) in an injectable formulation.Mostly because of the formulation (my PDR [a bit dated -- 1996] lists Stadol as the only one that comes in a non-injectable form) but also because they are not prescribed as much.
> > I know that some people have had good responses from morphine/oxycodone/methadone, but I'd rather not mess with anything potentially "addictive."
>
> I think that's reasonable. IMO, it's a good idea to try buprenorphine first, and move on to full agonists (probably MS Contin, OxyContin, or Duragesic) only if buprenorphine benefits you, but (1) the effect of buprenorphine is not sufficient, and you need something "stronger;" or (2) you are unable to tolerate buprenorphine. (Fentanyl is probably the most tolerable of the opioids, although it's probably a bad idea to ask your doctor for it.) I don't think it's worthwhile to try full agonists if buprenorphine doesn't help at all, although it's generally worth trying different doses -- sometimes higher doses may work better, but sometimes you may actually find *lower* doses more effective. In general, because the side effects of opioids can be pretty harsh, I'd advise starting at a low-end dose. (I started at 0.5 mL t.i.d.)> > Are there any other mixed agonists that are worth trying (and that don't require IV/IM injection)? Thanks for any information.
>
> Probably not. You might try Stadol (butorphanol), a kappa agonist/mu antagonist, especially if you're one of those people who feel worse on opioids (most people have at least tried codeine or hydrocodone at some point, so you're liable to have some idea how they affect you). But usually depressed people feel worse on kappa agonists. There was another drug on the market called Dalgan (dezocine) with a pharmacological profile similar to that of buprenorphine, but I think that dezocine is no longer available. (IIRC, Dalgan was an injection-only drug too, anyway.)I was going to try to get Stadol NS (Nasal Spray), but it seems like there are too few reasons not to try the "harder" opiates (Ultram doesn't seem to be very efficacious and I'm afraid of adding it to an MAOI [currently, I am taking Nardil]). The only opioids I've used were Vicodin and codeine. I remember the Vicodin making me feel somewhat better (both physically and psychically), but codeine did absolutely nothing at moderate doses (for my mood or my nasal pain).
> HTH
It does, thanks.
> BTW, buprenorphine doesn't have to be injected. It's effective when taken intranasally and sublingually (although the dose, at least in the latter case, is much higher than the injected dose).
>
> -eYeah, but it sounds like the alternative routes are a pain in the ass.
Thanks for your help,
Christophre
Posted by Kristi on January 25, 2002, at 1:05:49
In reply to Re: opioids » christophrejmc, posted by Elizabeth on January 24, 2002, at 12:47:08
Hi. I'm just curious...... you mentioned ultram is associated with seizures? I've been on it for a while, just wondering what you know. Thanks in advance, Kristi
> > Is there any reason why buprenorphine would be a better choice for depression than the other opiates?
>
> There are several, which are discussed in the Bodkin et al. article. The following factors make buprenorphine a better choice than a full agonist.
>
> - less toxicity in overdose
> - little or no potential for abuse or addiction
> - much milder withdrawal symptoms
> - lacks Ultram's potential for precipitating seizures
> - action lasts longer than most opioids
>
> > Strangely, it's easier for me to get schedule IIs than the lesser controlled opiates (legally, btw).
>
> Buprenorphine in particular, or less controlled opioids in general (e.g., Stadol, Talwin, Nubain, etc.)? Doctors often shy away from buprenorphine because it's only available (in the U.S.) in an injectable formulation.
>
> > I know that some people have had good responses from morphine/oxycodone/methadone, but I'd rather not mess with anything potentially "addictive."
>
> I think that's reasonable. IMO, it's a good idea to try buprenorphine first, and move on to full agonists (probably MS Contin, OxyContin, or Duragesic) only if buprenorphine benefits you, but (1) the effect of buprenorphine is not sufficient, and you need something "stronger;" or (2) you are unable to tolerate buprenorphine. (Fentanyl is probably the most tolerable of the opioids, although it's probably a bad idea to ask your doctor for it.) I don't think it's worthwhile to try full agonists if buprenorphine doesn't help at all, although it's generally worth trying different doses -- sometimes higher doses may work better, but sometimes you may actually find *lower* doses more effective. In general, because the side effects of opioids can be pretty harsh, I'd advise starting at a low-end dose. (I started at 0.5 mL t.i.d.)
>
> > Are there any other mixed agonists that are worth trying (and that don't require IV/IM injection)? Thanks for any information.
>
> Probably not. You might try Stadol (butorphanol), a kappa agonist/mu antagonist, especially if you're one of those people who feel worse on opioids (most people have at least tried codeine or hydrocodone at some point, so you're liable to have some idea how they affect you). But usually depressed people feel worse on kappa agonists. There was another drug on the market called Dalgan (dezocine) with a pharmacological profile similar to that of buprenorphine, but I think that dezocine is no longer available. (IIRC, Dalgan was an injection-only drug too, anyway.)
>
> HTH
>
> -elizabeth
Posted by BarbaraCat on January 25, 2002, at 14:25:01
In reply to p.s. chronic pain » BarbaraCat, posted by Elizabeth on January 23, 2002, at 13:35:04
Elizabeth
> Are you getting any treatment for the fibromyalgia?I take hydrocodone when the pain is bad, although it doesn't really help that much except to improve my general mood. I also take baclofen which supposedly relaxes the spasms. When I'm having a really bad spell about the only thing I can do is sedate myself with enough klonopin and baclofen to render myself unconscious, coming up only to eat and excrete. This, as you can imagine, is not what I'd call a life.
> Compounding the problem, there are several drugs on the market that are labelled as "muscle relaxants" which are really just antihistamines/anticholinergics and don't have any particular muscle relaxant effect; they're just sedating. (Some of them are structurally similar to the tricyclic ADs.)
Do you know of any true 'muscle relaxants'? My pain is compounded by anxiety which creates muscle armouring. Exercise is really my best therapy. If I can just get the muscles loose and my mental place in a nice alpha zone, I can usually start moving and push through the pain, but if I'm really down and hurting there's just no way I'm able to call forth the will.
> I have chronic musculoskeletal pain (in my back, neck, and shoulders) too, although it's not fibromyalgia (the doctor I saw at a pain clinic in Boston thinks that it's related to a slight flaw in some of my thoracic vertabrae which causes them to press against the joints in between. I had a steroid injection in the two joints in question which worked very well (for a week or so, that is), showing that the whole problem is due to those two tiny little joints! (Chronic pain is a very weird and poorly-understood phenomenon.) Unfortunately, this didn't do much good since there isn't a way to correct the problem at this time.
I've heard some good reports on prolo therapy. I've also received cortisone injections which help for structural related problems (old mountain climbing and car accidents), but the pain of fibromyalgia is a different animal. The pain is a migrating, all over deep muscle ache, like the pain felt with a flu. It's accompanied by severe fatigue and weakness, cognitive problems, and depression. I can't tell any longer where the division is between the fibro and the depression. I know they're interrelated, but to what extent are they the same disease? I sometimes get depression without the physical pain, but it's more the agitated sort. I wonder how many others out there are afflicted with very severe somatic complaints -- think I'll start a new poll/thread.
> Buprenorphine works very well for the pain as well as for the depression, and I haven't developed any tolerance to it. Of possible interest, Nardil also relieved the pain while I was taking it. I've also found Soma helpful. Benzos can help as well, although I think they are less reliable.
Isn't soma a benzo? BTW, are you taking the buprenorphine primarily as an antidepressant or as a pain reliever? Thanks for your input, Elizabeth. I always enjoy reading your posts.
Barbara
Posted by Elizabeth on January 30, 2002, at 5:49:59
In reply to Re: opioids » Elizabeth, posted by christophrejmc on January 25, 2002, at 1:01:58
Re pluses of buprenorphine:
> Thanks, although the last point is probably the only one that matters to me at this point.That's not surprising, but the others may be more important to your doctor!
> Mostly because of the formulation (my PDR [a bit dated -- 1996] lists Stadol as the only one that comes in a non-injectable form) but also because they are not prescribed as much.
It's true; all doctors (I'd hope) are familiar with MS Contin, whereas I've gotten some "huh?"s when I mentioned buprenorphine! Some of the slow-release formulations of some of the full agonists are longer-acting than buprenorphine. Duragesic, the fentanyl patch, is my favorite; it lasts three days, supposedly (some people find it doesn't last quite that long and need to change it every two days or so, one of the reasons I detest "one size fits all" dosing regimens). But there are good reasons to try buprenorphine before moving on to these drugs.
Say, how is the Nardil working for you? I presume you need help with residual symptoms (you don't seem "actively" depressed). That's been a chronic problem for me too; regular ADs help, but I have some symptoms that seem impervious to the standard psych drugs.
> I was going to try to get Stadol NS (Nasal Spray), but it seems like there are too few reasons not to try the "harder" opiates (Ultram doesn't seem to be very efficacious and I'm afraid of adding it to an MAOI [currently, I am taking Nardil]).
I've encountered a couple people who found that very high doses of Ultram worked even though it didn't do anything for them at the recommended doses. You're right that it shouldn't be taken with MAOIs, BTW; most other opioids are fine. (A notable exception is Demerol, but that would make a lousy AD anyway.)
> The only opioids I've used were Vicodin and codeine. I remember the Vicodin making me feel somewhat better (both physically and psychically), but codeine did absolutely nothing at moderate doses (for my mood or my nasal pain).
Codeine doesn't work for me either. I've learned recently (by way of a tricyclic serum level) that I may have a metabolic deficiency which would account for the lack of effect of codeine. (Nearly all of the analgesic effect of codeine is due to its metabolism into morphine; a deficiency in the enzyme that catalyzes this process -- which is also involved in the metabolism of TCAs -- generally makes codeine ineffective, at least at normal doses. This might be your problem as well, although it's hard to say for sure.)
> Yeah, but it sounds like the alternative routes are a pain in the ass.
I think that self-administering buprenorphine by IM injection would be easier to do in your arm rather than your ass (although both are viable sites)! :-)
-elizabeth
Posted by Elizabeth on January 30, 2002, at 6:01:48
In reply to Re: opioids-Elizabeth, posted by Kristi on January 25, 2002, at 1:05:49
> Hi. I'm just curious...... you mentioned ultram is associated with seizures? I've been on it for a while, just wondering what you know.
It has that reputation, and the potential for lowering the seizure threshold is noted in the Rx monograph (in the PDR). I've never encountered anybody who actually had seizures due to Ultram. I think it's probably a rare adverse effect, but that you should keep it in mind if you're considering taking Ultram, especially if you've had seizures in the past.
-elizabeth
Posted by Elizabeth on January 30, 2002, at 6:37:35
In reply to Re: p.s. chronic pain » Elizabeth, posted by BarbaraCat on January 25, 2002, at 14:25:01
> I take hydrocodone when the pain is bad, although it doesn't really help that much except to improve my general mood.
I think that mood, anxiety, and sleep problems are often tied up with fibromyalgia and perhaps other types of chronic pain. But anyway -- what dose of hydrocodone do you take?
> I also take baclofen which supposedly relaxes the spasms.
I tried it -- it had no effect at all, as far as I could tell. Didn't even help me sleep. It's labeled for "spasticity" (it's a direct GABA-B agonist) -- I'm not sure what that is exactly, but I think it's different from the muscle spasms which can be implicated in musculoskeletal pain.
Pretty much anything sedating can help somewhat, although I've found that things like antihistamines (which I call "incidentally" sedating) are only minimally and unreliably useful, and generally not worth the trouble.
> When I'm having a really bad spell about the only thing I can do is sedate myself with enough klonopin and baclofen to render myself unconscious, coming up only to eat and excrete. This, as you can imagine, is not what I'd call a life.
Jeez. If you have chronic pain, you need chronic treatment. (That makes sense, right?) That might mean taking a modest dose of Klonopin (or another benzo -- they might differ in muscle-relaxant effects, not sure) on a daily basis. I don't know. Chronic pain is very hard to treat, I think. Personally, I've found that buprenorphine helps *without causing tolerance*. I wonder if it would work for you too?
> Do you know of any true 'muscle relaxants'?
Soma (carisoprodol) and Miltown (meprobamate) seem to be good ones, although they can be sedating too. Benzos work for many people; I think that they could be taken on a regular basis and still work, especially since part of your problem is the pain - > anxiety - > more pain - > more anxiety ... cycle. (That is also a problem for me.) These can all be sedating, although most people will become tolerant to the sedation if they take them regularly for a little while. I can't think of anything else off the top of my head, but I'll let you know if I do.
Exercise -- just something simple like walking -- is often good, as you know. I think it's important to make a point of being active -- not necessarily becoming an exercise buff, just being active.
> I've heard some good reports on prolo therapy.
"Prolo therapy?"
> I've also received cortisone injections which help for structural related problems (old mountain climbing and car accidents), but the pain of fibromyalgia is a different animal.
Steroid injections really aren't something you should do on a regular basis, anyway.
> The pain is a migrating, all over deep muscle ache, like the pain felt with a flu.
Mine is sort of like that -- it "migrates," although it's limited to my back/neck/shoulders. In particular, it's usually concentrated on one side, although it may be either the left or the right. I don't really know much about flu pains -- I haven't had the flu in years, and these days I try to get the flu shot every year.
> It's accompanied by severe fatigue and weakness, cognitive problems, and depression.
Mine doesn't seem to be absolutely correlated with my mood or energy level, although there are some ways that my mood can affect the pain (e.g., inactivity from depression, muscle tension related to anxiety). I often have pain when I'm not depressed or anxious, though. (I recall one summer when my back pain was really bad and was present almost all the time -- that was when I decided to go to the pain clinic and got the steroid injection, the diagnosis, and the Soma -- when I was on Parnate and really wasn't doing too badly mood-wise. I was fairly active too -- did a lot of walking around Cambridge and Boston.)
> I can't tell any longer where the division is between the fibro and the depression. I know they're interrelated, but to what extent are they the same disease?
I don't know. Fibro is not very well-understood. It seems likely that there might be a common cause to the pain and the depression, though.
Have you checked out some of the fibromyalgia chat boards on the web, and if so, what sorts of things do other people find helpful?
> I wonder how many others out there are afflicted with very severe somatic complaints -- think I'll start a new poll/thread.
"Somatic complaints" is pretty broad -- it could include GI distress, skin problems such as psoriasis and eczema, appetite and sleep disturbances, and low energy (all of which are sometimes associated with anxiety and/or depression) as well as pain.
> Isn't soma a benzo?
No, although it's related to meprobamate (the predecessor to the benzos). I don't think anybody is sure how Soma works.
> BTW, are you taking the buprenorphine primarily as an antidepressant or as a pain reliever?
Antidepressant. Although maybe it would be easier to get it if I saw a pain doc. < sigh >
> Thanks for your input, Elizabeth. I always enjoy reading your posts.
Thanks :) It's nice to chat with you!
-elizabeth
Posted by therese desqueroux on January 30, 2002, at 18:14:31
In reply to Ultram » Kristi, posted by Elizabeth on January 30, 2002, at 6:01:48
Last year, a pain management specialist prescribed me Ultram for a severe back problem. My pdoc told me not to take it for the exact reasons Elizabeth noted.
Elizabeth, and some of you other folks out there, how do you know so much? (Rhetorical question).
----
> > Hi. I'm just curious...... you mentioned ultram is associated with seizures? I've been on it for a while, just wondering what you know.
>
> It has that reputation, and the potential for lowering the seizure threshold is noted in the Rx monograph (in the PDR). I've never encountered anybody who actually had seizures due to Ultram. I think it's probably a rare adverse effect, but that you should keep it in mind if you're considering taking Ultram, especially if you've had seizures in the past.
>
> -elizabeth
Posted by christophrejmc on January 31, 2002, at 1:14:13
In reply to Re: opioids » christophrejmc, posted by Elizabeth on January 30, 2002, at 5:49:59
> Re pluses of buprenorphine:
> > Thanks, although the last point is probably the only one that matters to me at this point.
>
> That's not surprising, but the others may be more important to your doctor!> > Mostly because of the formulation (my PDR [a bit dated -- 1996] lists Stadol as the only one that comes in a non-injectable form) but also because they are not prescribed as much.
>
> It's true; all doctors (I'd hope) are familiar with MS Contin, whereas I've gotten some "huh?"s when I mentioned buprenorphine! Some of the slow-release formulations of some of the full agonists are longer-acting than buprenorphine. Duragesic, the fentanyl patch, is my favorite; it lasts three days, supposedly (some people find it doesn't last quite that long and need to change it every two days or so, one of the reasons I detest "one size fits all" dosing regimens). But there are good reasons to try buprenorphine before moving on to these drugs.Fentanyl sounds great, but I'm not sure if my doctor will be able to continue prescribing it (he's not my doctor, but he's willing to let me try an opioid for my depression) -- the withdrawl would not be fun.
> Say, how is the Nardil working for you? I presume you need help with residual symptoms (you don't seem "actively" depressed). That's been a chronic problem for me too; regular ADs help, but I have some symptoms that seem impervious to the standard psych drugs.Nardil helps with some of my social phobia and it got me out of my most recent suicidal state. I still have problems with anhedonia, apathy, etc.
> > I was going to try to get Stadol NS (Nasal Spray), but it seems like there are too few reasons not to try the "harder" opiates (Ultram doesn't seem to be very efficacious and I'm afraid of adding it to an MAOI [currently, I am taking Nardil]).
>
> I've encountered a couple people who found that very high doses of Ultram worked even though it didn't do anything for them at the recommended doses. You're right that it shouldn't be taken with MAOIs, BTW; most other opioids are fine. (A notable exception is Demerol, but that would make a lousy AD anyway.)
>
> > The only opioids I've used were Vicodin and codeine. I remember the Vicodin making me feel somewhat better (both physically and psychically), but codeine did absolutely nothing at moderate doses (for my mood or my nasal pain).
>
> Codeine doesn't work for me either. I've learned recently (by way of a tricyclic serum level) that I may have a metabolic deficiency which would account for the lack of effect of codeine. (Nearly all of the analgesic effect of codeine is due to its metabolism into morphine; a deficiency in the enzyme that catalyzes this process -- which is also involved in the metabolism of TCAs -- generally makes codeine ineffective, at least at normal doses. This might be your problem as well, although it's hard to say for sure.)
>
> > Yeah, but it sounds like the alternative routes are a pain in the ass.
>
> I think that self-administering buprenorphine by IM injection would be easier to do in your arm rather than your ass (although both are viable sites)! :-)By alternative routes, I meant sublingual and intranasal (I think you knew that and were making a joke, but I thought I'd make sure). Why don't you use the IM route, btw? What are the downsides?
> -elizabeth
-christophre
Posted by Elizabeth on February 1, 2002, at 15:22:50
In reply to Re: Ultram, posted by therese desqueroux on January 30, 2002, at 18:14:31
> Last year, a pain management specialist prescribed me Ultram for a severe back problem. My pdoc told me not to take it for the exact reasons Elizabeth noted.
Do you have a history of seizures or any other reason to think you're at risk? I think that Ultram is probably okay for most people if taken in the normal dose range. Is your back doing better, BTW?
> Elizabeth, and some of you other folks out there, how do you know so much? (Rhetorical question).
I don't really know that much, but I do try to share what I know when someone has a question. Most of what I know I learned from reading stuff. I've also picked up a lot of "real life" information, about the effects meds have on people and how frequent they are and so on, in support groups (including online ones such as this one). I think that doctors would benefit a lot from reading this stuff.
-elizabeth
Posted by Elizabeth on February 1, 2002, at 15:47:02
In reply to Re: opioids » Elizabeth, posted by christophrejmc on January 31, 2002, at 1:14:13
> Fentanyl sounds great, but I'm not sure if my doctor will be able to continue prescribing it (he's not my doctor, but he's willing to let me try an opioid for my depression) -- the withdrawl would not be fun.
This is one point in favor of seeing if buprenorphine works before you start considering that full agonists: withdrawal symptoms from stopping buprenorphine are very mild.
OTOH, you don't have to take an opioid that long to find out if it works -- just long enough to figure out what dose you need.
Do you think you'd be able to get by taking an opioid on an as-needed basis, rather than continuously, and continuing with the Nardil? That might be better than taking the opioid full-time. I think there is some risk of tolerance to opioids for people taking them as ADs (although there definitely are people who don't become tolerant), and it's also a challenge to manage some of the side effects on a day-to-day basis.
> Nardil helps with some of my social phobia and it got me out of my most recent suicidal state. I still have problems with anhedonia, apathy, etc.
My residual symptoms are similar, and buprenorphine definitely helps a lot. Have you tried psychostimulants?
> > I think that self-administering buprenorphine by IM injection would be easier to do in your arm rather than your ass (although both are viable sites)! :-)
>
> By alternative routes, I meant sublingual and intranasal (I think you knew that and were making a joke, but I thought I'd make sure).The ass part was a joke. (Although it's true that buprenorphine would be absorbed by intramuscular injection in the butt, it probably wouldn't hurt much.)
But yes, there are problems with SL and IN administration. I have often thought it would be cool if buprenorphine were available in a metered-dose nasal inhaler (a la Stadol NS); that would make it very easy to take it that way. I gather that a problem with taking the injectable solution sublingually is that it isn't absorbed reliably, so it sometimes doesn't work as well as it's supposed to.
> Why don't you use the IM route, btw? What are the downsides?
I'm not sure how my pdoc would react if I asked if I could do this. I also think there might be problems with getting IM injections three times a day, every day (you could alternate which muscle you used, of course, but even then you'd be hitting the same site pretty often).
-elizabeth
Posted by christophrejmc on February 3, 2002, at 17:18:09
In reply to Re: opioids » christophrejmc, posted by Elizabeth on February 1, 2002, at 15:47:02
> Do you think you'd be able to get by taking an opioid on an as-needed basis, rather than continuously, and continuing with the Nardil? That might be better than taking the opioid full-time. I think there is some risk of tolerance to opioids for people taking them as ADs (although there definitely are people who don't become tolerant), and it's also a challenge to manage some of the side effects on a day-to-day basis.
I never even thought about that; I think I'll try that first.
> My residual symptoms are similar, and buprenorphine definitely helps a lot. Have you tried psychostimulants?
Yeah. They help, but not much. I'm currently thinking about adding a direct dopamine agonist, it seems to help some people with residual anhedonia/apathy.
> I have often thought it would be cool if buprenorphine were available in a metered-dose nasal inhaler (a la Stadol NS); that would make it very easy to take it that way.
Have you thought about filling an OTC nasal spray with buprenorphine (the good ones that control the amount of fluid sprayed)? I wonder if certain pharmacies can do this for you.
> I'm not sure how my pdoc would react if I asked if I could do this. I also think there might be problems with getting IM injections three times a day, every day (you could alternate which muscle you used, of course, but even then you'd be hitting the same site pretty often).
Yeah, I can see the problem there.
-chris
Posted by Elizabeth on February 3, 2002, at 21:45:24
In reply to Re: opioids, posted by christophrejmc on February 3, 2002, at 17:18:09
> > Have you tried psychostimulants?
>
> Yeah. They help, but not much. I'm currently thinking about adding a direct dopamine agonist, it seems to help some people with residual anhedonia/apathy.My pdoc did some clinical research with one of those a few years ago and wasn't impressed. Then again he's generally not impressed by *anything*. < g > Mirapex seems to have a good (though brief) record as an antidepressant, and it would be my first choice if I were going to try a direct DA agonist.
> Have you thought about filling an OTC nasal spray with buprenorphine (the good ones that control the amount of fluid sprayed)?
It'd have to be *very* precise. Are there any OTC ones like that? (Yes, I've thought about it.)
> I wonder if certain pharmacies can do this for you.
A compounding pharmacy could do it, but there aren't many of those. I'm not sure if a regular pharmacy could do it. Does anybody know?
-elizabeth
Posted by IsoM on February 3, 2002, at 23:26:18
In reply to Re: opioids, and a pharmacy question (Cam?) » christophrejmc, posted by Elizabeth on February 3, 2002, at 21:45:24
> > "...Have you thought about filling an OTC nasal spray with buprenorphine (the good ones that control the amount of fluid sprayed)?
>
> It'd have to be *very* precise. Are there any OTC ones like that?"*****************************
Just stepping in for a minute with a comment, if you don't mind ---I use a nasal prescription spray called Atrovent (for something entirely different). The 15 ml bottle gives 165 measured sprays. If you know stereochemistry, you can work out the dilution of the medication you're discussing to get an exact amount each time. Each spray gives the same amount of medication. The small plastic container can be rinsed out & reused. I reuse mine to make my own saline nasal spray.
If you don't trust yourself to do the calculations, I'm sure a high school chemistry teacher would be more than willing to help.
Posted by Elizabeth on February 4, 2002, at 15:14:48
In reply to Exact Amounts and Nasal Sprays » Elizabeth, posted by IsoM on February 3, 2002, at 23:26:18
> Just stepping in for a minute with a comment, if you don't mind ---
Of course not. I very much appreciate it.
> I use a nasal prescription spray called Atrovent (for something entirely different).
I don't use Atrovent or anything like it; how would I go about getting a metered-dose inhaler? Do you think a pharmacist would be willing to give or sell me one? Or do I have to seek out the shady underground trade in empty medication containers?
> If you don't trust yourself to do the calculations, I'm sure a high school chemistry teacher would be more than willing to help.
I'm not *that* out of practice! :-)
-elizabeth
Posted by IsoM on February 4, 2002, at 17:00:19
In reply to Re: Exact Amounts and Nasal Sprays - thanks! » IsoM, posted by Elizabeth on February 4, 2002, at 15:14:48
Sorry, Elizabeth, I don't know your background & the forum users encompass a wide range. Someone who might not be familiar with chemistry would just gasp at the thought. What is your background and/or career anyway, if you don't mind me asking?
Posted by IsoM on February 4, 2002, at 18:43:16
In reply to Not That Out of Practice » Elizabeth, posted by IsoM on February 4, 2002, at 17:00:19
Elizabeth, both you & sid write in a lucid wmanner & I enjoy reading your posts simply to learn more. Seeing that these posts are public on the forum, I didn't feel like I was sneaking about when I read your's & sid's postings regarding depression (& earlier CBT). Reading them over, I see that you're a mathematician by training. I apologise whether you could do the calculations - a breeze for you, I'd imagine.
Like you & sid, I love math, and if I could do nothing but math, I'd be happy & good at it. Trouble is, I have to set my mind in gear for math, I can't just switch focus & work on a different subject, & vice versa. To do math well, I need to work at it for hours. Friends couldn't understand how I'd find hours of math homework enjoyable, but I did.
An example of how I do math is --
One time in my calculus class as the prof was explaining & writing out some new thoughts on the board, filling up one board after another, I put up my hand & said "then it follows that...etc" & I went on to ask if it would tie in with some of the other things just learned & what the graph would be like. He was so pleased & happy to see someone grasp it so quickly & see the applications (he thought he had a star student, poor guy). Then he erased everything from the board, wrote up some problems & told us to try them with what we just learned. I couldn't even begin.After grasping the concept so beautifully (I see math as very beautiful), I couldn't even remember what the first step was! I hate the way my brain operates. I need to have the steps written down in front of me to guide me. Then I have to do it over & over & over to wear a pathway in my memory, else the next day, my mind is as empty as before. I explainmy mind as a huge hard-drive, but very little working RAM, & the 'search' feature doesn't work most times. I'm so, so hoping adrafinil will help my memory. Long-term memory is excellent, comprehension is excellent, but short-term & midshort-term (working memory) is absolutely crappy, which means not much happens. :-(
I respect your views. So if you've got any idea on how to improve shor-term & working memory - meds wise too, let me know. I tried all the study guides offered at university. It helps somewhat.
P.S. about driving & getting a licence. I lived on the prairies for 14 years & one could drive for an hour & only pass the occasional car. When I moved back to the Vancouver area, I figured I'd never be able to drive. The traffic was incredible. There was just too much to pay attention to & still react in time. I finally screwed up my courage & bid my sons good-bye. I told the older ones in all seriousness, I hoped I wouldn't get in an accident. Driving's a snap now. I never really relax when I drive - I always consider it a challenge - me against them so I'm always superalert. But it comes to you.
Start with small drives to someone's house close by, etc & work your way up. The nice thing about driving is that it becomes kinetic memory & you're not consciously aware of your movements - like riding a bike. You just need to watch your surroundings & all other things will be automatic.
Posted by Elizabeth on February 7, 2002, at 10:57:32
In reply to Career and Interests » IsoM, posted by IsoM on February 4, 2002, at 18:43:16
> ...I see that you're a mathematician by training. I apologise whether you could do the calculations - a breeze for you, I'd imagine.
Actually, I meant I'm not that out of practice in chemistry! I'm 25 and I've been struggling with depression since I was 14 (possibly younger, but that was the first time I was seriously impaired by it and sought treatment). So I don't have a career. After I graduated from college, I went to grad school (in math) briefly, but I got very depressed again while I was there. (This was while I was taking Nardil, an AD that seemed to be working pretty well for several months but then pooped out in a disastrous way. I tried it twice and this happened both times.) While I was recovering, I decided I wanted to be a doctor. I still need to take a couple of classes and the MCAT before I can apply, though, and it could be a while before I do that (right now what I need is some money, so getting a job is higher on my agenda).
> Trouble is, I have to set my mind in gear for math, I can't just switch focus & work on a different subject, & vice versa. To do math well, I need to work at it for hours.
My problem is mainly with shifting focus, I think. If I can focus on something, I can *really* focus on it. This doesn't help if you're trying to do something that requires frequently shifting your attention from one thing to another (like, say, driving).
> He was so pleased & happy to see someone grasp it so quickly & see the applications (he thought he had a star student, poor guy).
He probably was thrilled to find someone who was interested in the material, too! (speaking as someone who's taught math)
> After grasping the concept so beautifully (I see math as very beautiful), I couldn't even remember what the first step was! I hate the way my brain operates.
I know the feeling. Although it sounds like my attention problems and yours aren't exactly the same, it's really frustrating to enjoy something and be good at it and want to do it but not be able to.
> Then I have to do it over & over & over to wear a pathway in my memory, else the next day, my mind is as empty as before.
"Wear a pathway in your memory" is a pretty good analogy, actually. Hmm...I wonder if there could be a connection between your memory-attention problems and your sleep architecture?
> I respect your views. So if you've got any idea on how to improve shor-term & working memory - meds wise too, let me know.
I think that we need to look more closely at different types of attentional problems. The category of "ADD" is too broad and doesn't capture anything of what's going on when a person tries to focus (and none of the diagnostic categories goes into more detail about attention *symptoms*, which may or may not be associated with ADD). A lot of the problem is that it's considered a disorder of childhood, so the diagnostic criteria are pretty much entirely behavioral. This is understandable since it's often hard for children to explain what's going on in their heads, but I think we need to try to understand ADD and other attention problems better. A good way to start would be to listen to adults who have attention or concentration problems describe their problems in detail.
Anyway...it sounds to me like, in your case, it's a matter of being able to maintain focus, though, so adrafinil seems like a good idea. Have you ever tried piracetam (or one of the other *racetams)?
> Start with small drives to someone's house close by, etc & work your way up. The nice thing about driving is that it becomes kinetic memory & you're not consciously aware of your movements - like riding a bike. You just need to watch your surroundings & all other things will be automatic.
I'm not there yet, but I've gotten to be pretty good at it, and a lot of things do come naturally. But I still can't pass the ****ing test! (I'm embarrassed to say how many times I've tried.)
-elizabeth
Posted by IsoM on February 7, 2002, at 13:43:27
In reply to Re: careers, attention/memory, etc. » IsoM, posted by Elizabeth on February 7, 2002, at 10:57:32
> > "...Have you ever tried piracetam (or one of the other *racetams)?"
I'll look into that, do lots of reading & see if it may be applicable for me.
I've seen PET scans of people with ADD trying to concentrate vs ordinary brains. What I've never seen is a PET scan of an ADD individual who's hyperfocusing. I'm curious to what part of the brain is activated there. I know that when I do hyperfocus (not something one forces but just happens with some subjects one is intensely interested in), everything comes together so smoothly & quickly. Though it doesn't necessarily stay in my memory!
About your driver's test, have you considered (I'm sure you have) taking a tranquiliser & a stimulant together? They don't counter each other but will complement each under what I know can be very stressful conditions. Where do most driving examiners come from - the depths of Hell & then some? I've never met such a scowling, unfriendly bunch before - designed to make a professional driver quake in his boots.
Posted by reese1 on February 7, 2002, at 17:31:03
In reply to Re: Ultram » therese desqueroux, posted by Elizabeth on February 1, 2002, at 15:22:50
dear elizabeth and everyone else,
my pdoc put me on ultram instead of buprenex because she thinks it is not legal yet. so she gave me ultram. does ultram have any effect? has anyone had expierence with it?
i am taking 50mg pills only one pill split in half a day, for the first week then i will eventually take one pill twice a day
if this does not work she said methodone possibility my hairs stood up and i said no way i want to take buprenex and she said she would have to find someone who uses it.
strange. she has the licensce to prescribe methadone but not buprenex.
does anyone have any information, current, that says it is legal for pdoc to prescribe buprenex
thank you
reese
Posted by Elizabeth on February 7, 2002, at 23:48:12
In reply to pdoc put me on ultram instead of buprenex?, posted by reese1 on February 7, 2002, at 17:31:03
> does anyone have any information, current, that says it is legal for pdoc to prescribe buprenex
It is. Buprenorphine is Schedule V. Perfectly legal. Why didn't you just tell your doctor it's legal?
-elizabeth
Posted by Elizabeth on February 7, 2002, at 23:52:17
In reply to Passing the Driver's test » Elizabeth, posted by IsoM on February 7, 2002, at 13:43:27
> I'll look into that, do lots of reading & see if it may be applicable for me.
Tell me what you find out. I haven't got any material on those.
> About your driver's test, have you considered (I'm sure you have) taking a tranquiliser & a stimulant together?
Um, not particularly. But buprenorphine, which I take three times a day, is a stimulant for me, and I think I probably took Xanax before taking the driving test.
> They don't counter each other but will complement each under what I know can be very stressful conditions.
Yup, they can. (But which is yin and which is yang?)
> Where do most driving examiners come from - the depths of Hell & then some?
That sounds about right!
> I've never met such a scowling, unfriendly bunch before - designed to make a professional driver quake in his boots.
Yeah, they're pretty vicious bastards.
-elizabeth
Posted by reese1 on February 8, 2002, at 1:07:56
In reply to Re: pdoc put me on ultram instead of buprenex? » reese1, posted by Elizabeth on February 7, 2002, at 23:48:12
i tried over and over and over again and she said she was at the last meeting and it was not yet allowed
i'm going to bring in a shit load of information i found on the web under pain managment which proves it's legal and schedule v
thank you
Posted by IsoM on February 8, 2002, at 14:43:49
In reply to Re: Passing the Driver's test » IsoM, posted by Elizabeth on February 7, 2002, at 23:52:17
> > "...Tell me what you find out (about piracetam or any other *racetams). I haven't got any material on those."
I'm doing some reading on piracetam. Not enough solid information to make any decision right now. I may just let the adrafinil do what I want - enhanced memory - but I'd still like to learn more about piracetam, find if there's any interaction between it & adrafinil. If I could get my memory working well, how knows what I may do? What an on-top-of-the-world feeling that would be!
With the absessed tooth I had, I was taking lots of codeine painkillers & Ativan to dull it. I felt so thick - couldn't think, let alone remember. I felt so mentally dull - nothing seemed to interest me in reading, TV or computer. I'm sure you've read the story "Flowers For Algenon". I don't mean to be arrogant about my intelligence, but the difference I felt was horrible. I enjoy my intelligence (it makes life so much more interesting) & would hate to imagine what it would be like to lose it. If I can incorporate a good memory into it too, well...!!
> > "...Um, not particularly. But buprenorphine, which I take three times a day, is a stimulant for me, and I think I probably took Xanax before taking the driving test."So do you think it helped you with being more relaxed during the test? I found with myself, mistakes I made were due to "the evil one" watching every move I made to such an extent I felt so shakey. I wonder if they figure you can drive well under such adverse conditions, you can handle anything. :-)
Where you're living now (at family home, I think), can you still continue some sort of studies or such on-line? I know with computer science, there's so many excellent on-line courses that can be used towards a bachelor's degree. Elizabeth, can you tell me if there's any practical applications of knot theory? As one math prof told me, most of the time, theories are developed & years later some application is found that applies to them. Also another question, if I wanted to learn more about fractal math (geometry), do you know what areas of math leads to it? I would dearly love to pursue more on fractals, but have no idea of what fields one needs to study to work my way there.
Posted by Elizabeth on February 8, 2002, at 23:26:04
In reply to Re: pdoc put me on ultram instead of buprenex?, posted by reese1 on February 8, 2002, at 1:07:56
> i tried over and over and over again and she said she was at the last meeting and it was not yet allowed
"Meeting?"
Any doctor can prescribe any drug that's legal. Buprenorphine is legal; it's been approved by the FDA. The only situation in which it would possibly be illegal would be if she were prescribing it for the maintenance of an opioid addiction.
It really sounds like your doctor doesn't understand the laws that affect her practice.
-elizabeth
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